Managing clinically insignificant aortic valve disease in patients undergoing CABG

The studies that have addressed combined CABG and AVR in those with significant coronary artery disease and asymptomatic aortic valve disease offer important insight into the management of this subset of patients. From the information available, we can conclude that replacing the aortic valve at the same time as CABG is not associated with increased perioperative or long-term mortality. Aortic valve replacement at the time of coronary bypass surgery is also associated with a significantly lower need for reoperation for AVR. Avoiding a second surgery has advantages in terms of morbidity and mortality, and may have overall cost advantages as well. The difficulty in accurately predicting the rate of progression of aortic valve disease, and the increased need for valve replacement in this subgroup of patients after a relatively short follow-up period suggests a more aggressive approach may be appropriate. Based on the information available, we currently recommended that patients referred for coronary bypass surgery who also have moderate aortic valvular disease undergo AVR at the same time. Please note: The authors have provided a reference listing that may be obtained from the editorial office.