Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer

Abstract

Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future.

Keywords: Gorlin area; aortic stenosis; aortic valve area; continuity equation; coronary artery bypass grafting; effective orifice area; ellipse; geometric orifice area; minimally invasive; port access; pressure recovery; risk stratification; sutureless; three-dimensional imaging; transcatheter aortic valve replacement; transesophageal echocardiography.