Management of mild aortic stenosis in patients undergoing coronary bypass surgery

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Similarly, patients with severe AS undergoing surgery on other valves (such as MV repair) or the aortic root should also undergo AVR as part of the surgical procedure. In patients with moderate AS, it is generally accepted practice to perform AVR at the time of CABG (181)(182)(183)(184)(185). Many clinicians also recommend AVR for moderate AS at the time of MV or aortic root surgery (for further detail, see Section 3.7, "Multiple Valve Disease").…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…In patients with moderate AS, it is generally accepted practice to perform AVR at the time of CABG. [181][182][183][184][185] Many clinicians also recommend AVR for moderate AS at the time of MV or aortic root surgery (for further detail, see Section 3.7, "Multiple Valve Disease"). However, there are no data to support a policy of AVR for mild AS at the time of CABG, with the exception of those patients with moderate to severe valvular calcification.…”

“…However, there are no data to support a policy of AVR for mild AS at the time of CABG, with the exception of those patients with moderate to severe valvular calcification. 98,181,182,[185][186][187] Recommendations for AVR at the time of CABG are discussed in Section 10.4. …”

“…Although definitive data are not yet available, patients with intermediate aortic valve gradients (mean gradient 30 to 50 mm Hg at catheterization or transvalvular velocity of 3 to 4 m per second by Doppler echocardiography) who are undergoing CABG may warrant AVR at the time of revascularization, [181][182][183][184][185] whereas patients with gradients below 10 mm Hg do not need valve replacement. The degree of mobility and calcification are also important factors predicting more rapid progression of aortic disease and should be taken into consideration, particularly in those with gradients between 10 and 25 mm Hg.…”

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary

“…In patients with moderate AS, it is generally accepted practice to perform AVR at the time of CABG (108 -112). However, there are no data to support a policy of AVR for mild AS at the time of CABG, with the exception of those patients with moderate to severe valvular calcification (29,108,109,(112)(113)(114). Recommendations for AVR at the time of CABG are discussed in Section X-D. (115)(116)(117)(118), and restenosis and clinical deterioration occur within 6 to 12 months in most patients (116,119 -122).…”