58
Surgical Considerations in Patients With CAD
Table 38. Surgical Considerations in Patients With VHD
Recommendations
COR LOE
Evaluation of Coronary Anatomy
Coronary angiography is indicated before valve intervention
in patients with symptoms of angina, objective evidence of
ischemia, decreased LV systolic function, history of CAD,
or coronary risk factors (including men age >40 years and
postmenopausal women).
I C
Coronary angiography should be performed as part of the
evaluation of patients with chronic severe secondary MR.
I C
Surgery without coronary angiography is reasonable for patients
having emergency valve surgery for acute valve regurgitation,
disease of the aortic sinuses or ascending aorta, or IE.
IIa C
CT coronary angiography is reasonable to exclude the
presence of significant obstructive CAD in selected patients
with a low/intermediate pretest probability of CAD. A
positive coronary CT angiogram (the presence of any
epicardial CAD) can be confirmed with invasive coronary
angiography.
IIa B
Intervention for CAD
CABG or percutaneous coronary intervention (PCI) is
reasonable in patients undergoing valve repair or replacement
with significant CAD (≥70% reduction in luminal diameter in
major coronary arteries or ≥50% reduction in luminal diameter
in the le main coronary artery).
IIa C
Intervention for AF
A concomitant maze procedure is reasonable at the time
of MV repair or replacement for treatment of chronic,
persistent AF.
IIa C
A full biatrial maze procedure, when technically feasible, is
reasonable at the time of MV surgery, compared with a lesser
ablation procedure, in patients with chronic, persistent AF.
IIa B
A concomitant maze procedure or pulmonary vein isolation
may be considered at the time of MV repair or replacement in
patients with paroxysmal AF that is symptomatic or associated
with a history of embolism on anticoagulation.
IIb C
A concomitant maze procedure or pulmonary vein isolation
may be considered at the time of cardiac surgical procedures
other than MV surgery in patients with paroxysmal or
persistent AF that is symptomatic or associated with a history
of emboli on anticoagulation.
IIb C
Catheter ablation for AF should NOT be performed in
patients with severe MR when mitral repair or replacement is
anticipated, with preference for the combined maze procedure
plus MV repair.
III: Harm B
