Recommendations A. Recommendations for management of CAD in patients with VHD.
| Recommendations | Classa | Levelb |
|---|---|---|
| Diagnosis of CAD | ||
| Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following: • History of cardiovascular disease. • Suspected myocardial ischaemia.c • LV systolic dysfunction. • In men >40 years of age and postmenopausal women. • One or more cardiovascular risk factors. |
I | C |
| Coronary angiography is recommended in the evaluation of severe SMR. | I | C |
| Coronary CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD.d | IIa | C |
| Indications for myocardial revascularization | ||
| CABG is recommended in patients with a primary indication for aortic/mitral/tricuspid valve surgery and coronary artery diameter stenosis ≥70%.e,f | I | C |
| CABG should be considered in patients with a primary indication for aortic/mitral/tricuspid valve surgery and coronary artery diameter stenosis ≥50-70%. | IIa | C |
| PCI should be considered in patients with a primary indication to undergo TAVI and coronary artery diameter stenosis >70% in proximal segments. | IIa | C |
| PCI should be considered in patients with a primary indication to undergo transcatheter mitral valve intervention and coronary artery diameter stenosis >70% in proximal segments. | IIa | C |
| CABG: coronary artery bypass grafting; CAD: coronary artery disease; CT: computed tomography; LV: left ventricle/left ventricular; PCI: percutaneous coronary intervention; SMR: secondary mitral regurgitation; TAVI: transcatheter aortic valve implantation; VHD: valvular heart disease. aClass of recommendation. bLevel of evidence. cChest pain, abnormal non-invasive testing. dCoronary CT angiography may also be used in patients requiring emergency surgery with acute infective endocarditis with large vegetations protruding in front of a coronary ostium. eStenosis ≥50% can be considered for left main stenosis. fFFR ≤0.8 is a useful cut-off indicating the need for an intervention in patients with mitral or tricuspid diseases, but has not been validated in patients with aortic stenosis. Adapted from 45,72 | ||