Valvular heart disease surgery

	Valvular heart disease Microchapters
Patient Information
Classification Aortic stenosis Aortic regurgitation Mitral stenosis Mitral valve prolapse Mitral regurgitation Tricuspid stenosis Tricuspid regurgitation Pulmonary stenosis Pulmonary regurgitation
Differential Diagnosis

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2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease ^[1]

Class I
"1. Coronary angiography is indicated before valve surgery (including infective endocarditis) or mitral balloon commissurotomy in patients with chest pain, other objective evidence of ischemia, decreased LV systolic function, history of CAD, or coronary risk factors (including age). Patients undergoing mitral balloon valvotomy need not undergo coronary angiography solely on the basis of coronary risk factors. (Level of evidence: C)"
"2. Coronary angiography is indicated in patients with apparently mild to moderate valvular heart disease but with progressive angina (Canadian Heart Association functional Class II or greater), objective evidence of ischemia, decreased LV systolic function, or overt congestive heart failure. (Level of evidence: C)"
"3. Coronary angiography should be performed before valve surgery in men aged 35 years or older, premenopausal women aged 35 years or older who have coronary risk factors, and postmenopausal women. (Level of evidence: C)"

Class III
"1. Coronary angiography is not indicated in young patients undergoing nonemergency valve surgery when no further hemodynamic assessment by catheterization is deemed necessary and there are no coronary risk factors, no history of CAD, and no evidence of ischemia. (Level of evidence C)"
"2. Patients should not undergo coronary angiography before valve surgery if they are severely hemodynamically unstable. (Level of evidence C)"

Class IIa
"1. Surgery without coronary angiography is reasonable for patients having emergency valve surgery for acute valve regurgitation, aortic root disease, or infective endocarditis. (Level of evidence C)"

Class IIb
"1. Coronary angiography may be considered for patients undergoing catheterization to confirm the severity of valve lesions before valve surgery without pre-existing evidence of CAD, multiple coronary risk factors, or advanced age. (Level of evidence C)"

2008 and incorporated 2006 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease ^[1]

↑ ^1.0 ^1.1 ^1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)