Coronary Evaluation in Elderly Patients with Severe Aortic Regurgitation

Rationale for Coronary Assessment

• The American College of Cardiology recommends preoperative coronary angiography in elderly patients with severe aortic regurgitation prior to surgical intervention, as determined by age, symptoms, and coronary risk factors 1

Indications for Coronary Angiography

• The European Society of Cardiology indicates that coronary angiography is recommended for all elderly patients (particularly >70 years) with severe AR being considered for surgical intervention 1, 2

Timing and Integration with Surgical Planning

• The American College of Cardiology suggests that coronary angiography should be performed during the preoperative evaluation phase, before proceeding to aortic valve surgery, allowing for combined coronary artery bypass grafting (CABG) and aortic valve replacement when indicated 1, 2, 3
• Patients with severe AR undergoing CABG should have concomitant aortic valve surgery, as recommended by the European Society of Cardiology 2, 3

Alternative Diagnostic Approaches

• The American College of Cardiology recommends that CT imaging can evaluate both coronary anatomy and aortic pathology simultaneously, and stress echocardiography is reasonable to assess hemodynamics and severity of regurgitation 4, 5, 3
• The American Heart Association suggests that cardiac catheterization may be needed when echocardiography is non-diagnostic or shows discordance with clinical findings 1