ABSTRACT
The incidence of combined coronary and valvular heart disease is increasing as the general population ages. Overall, 40% of patients with valvular heart disease will have concomitant coronary artery disease (CAD) with the combination of calcifi c aortic stenosis and CAD the most frequently encountered combination. Yet, data regarding optimal strategies for diagnosis and treatment of CAD in such patients are limited. Coronary angiography is recommended in all patients with a primary indication for valve surgery, apart from young patients (men younger than 40 years and pre-menopausal women) with no risk factors for CAD or when the risks of angiography outweigh the benefi ts. Coronary artery bypass grafting (CABG) should be performed in patients with a primary indication for heart valve surgery for all coronary arteries with stenosis above 70%. Mitral valve surgery is indicated in patients with a primary indication for CABG and severe ischemic mitral regurgitation. Recently published guidelines on combined valve surgery and CABG highlight out the increased mortality risk of a single combined operation. This observation, in conjunction with the higher risk profi le of patients currently referred for surgery, has provoked discussion regarding the optimal therapeutic approach in patients with dual pathology. Alternative treatment strategies include “hybrid” percutaneous coronary intervention procedures with scheduled surgery for valve replacement or transcatheter aortic valve implantation with prior percutaneous coronary intervention. At present, however, the data on hybrid procedures are very limited and further studies are warranted to establish the clinical utility of these approaches.
