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Mortality and need for reoperation in patients with mild-to-moderate asymptomatic aortic valve disease undergoing
J Hochrein1, J C Lucke, J K Harrison
1Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Insights
Patients with asymptomatic aortic valve disease undergoing coronary artery bypass graft (CABG) surgery should consider aortic valve replacement (AVR) during the procedure. This approach reduces the need for future aortic valve reoperation compared to CABG alone.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Aortic Stenosis and Insufficiency
Background:
- Concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI) is common in patients undergoing coronary artery bypass graft (CABG) surgery.
- The optimal management strategy for these patients remains a clinical challenge.
Purpose of the Study:
- To evaluate and compare clinical outcomes in patients with asymptomatic aortic valve disease undergoing CABG with or without concomitant aortic valve replacement (AVR).
- To assess the impact of AVR on mortality and reoperation rates.
Main Methods:
- Retrospective study comparing two groups: combined AVR and CABG (AVR-CABG group, n=414) versus CABG alone (CABG group, n=62) for asymptomatic mild-to-moderate AS/AI.
- Primary end points included 30-day mortality, cardiac mortality, all-cause mortality, and time to aortic valve reoperation.
- Cox proportional-hazards and logistic regression analyses were used to compare outcomes, controlling for patient characteristics.
Main Results:
- No significant differences in 30-day mortality, cardiac mortality, or all-cause mortality were observed between the AVR-CABG and CABG groups after adjustment.
- The need for aortic valve reoperation was significantly higher in the CABG group (24.3% at 6 years) compared to the AVR-CABG group (3%).
Conclusions:
- Performing aortic valve replacement (AVR) concurrently with coronary artery bypass graft (CABG) surgery in patients with asymptomatic aortic valve disease significantly reduces the likelihood of future reoperation.
- Consideration of AVR at the time of CABG is recommended for patients with asymptomatic AS or AI to improve long-term outcomes.
Background:
Patients presenting for coronary artery bypass graft (CABG) surgery may have concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR).
Methods:
Study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients with asymptomatic mild-to-moderate AS, AI, or both undergoing CABG but not AVR (CABG group). End points included 30-day mortality rate, time to cardiac mortality, time to all-cause mortality, and time to aortic valve reoperation. Reoperation refers to surgery for replacement of the native aortic valve in the CABG group or replacement of the prosthetic aortic valve in the AVR-CABG group. Important patient characteristics affecting outcomes were determined by using Cox proportional-hazard analysis. These variables were then included in multivariable analyses by using logistic regression analysis and Cox proportional-hazard modeling to compare outcomes between each patient group.
Results:
No difference was seen in any of the mortality end points between the CABG group and the AVR-CABG group after controlling for significant differences between the groups. However, the need for reoperation for AVR was significantly higher for the CABG group than the AVR-CABG group. For patients followed for up to 6 years, the estimated need for aortic valve reoperation was 24.3% in the CABG group versus 3% in the AVR-CABG group.
Conclusion:
On the basis of these results, patients with asymptomatic AS or AI should be considered for AVR at the time of CABG.