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Concomitant AVR During CABG — EECC MCQ

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ModerateValvular Heart DiseaseConcomitant AVR During CABGEECC

A 75-year-old man with moderate aortic stenosis (AVA 1.2 cm², mean gradient 28 mmHg, Vmax 3.5 m/s) is scheduled for elective CABG. Should concomitant AVR be performed?

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Correct answer: D — Concomitant AVR should be considered in patients with moderate AS undergoing cardiac surgery for other indications, to avoid the need for future redo surgery

The 2025 ESC/EACTS VHD Guidelines recommend that concomitant AVR should be considered (Class IIa) in patients undergoing cardiac surgery for other indications (e.g. CABG, mitral surgery) when moderate aortic stenosis is present, as: (1) AS typically progresses at a rate of ~0.1-0.3 m/s per year in Vmax, meaning moderate AS will likely become severe within 3-5 years; (2) redo sternotomy for future isolated AVR carries significantly higher risk than concomitant AVR at the time of index surgery. The incremental surgical risk of adding AVR to CABG is modest in experienced hands. This is a shared decision involving the Heart Team and patient.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease