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Updated: Aug 14, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass
Cary W Akins1, Alan D Hilgenberg, Gus J Vlahakes
1Department of Surgery, Massachusetts General Hospital, Boston 02114, USA. cakins@partners.org
Insights
Combined aortic valve replacement and coronary artery bypass grafting surgery impacts long-term survival. Mechanical valves showed worse survival and more complications than bioprosthetic valves, despite similar reoperation rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Prosthetic Valve Research
Background:
- Concomitant coronary artery disease and aortic valve disease are linked to reduced long-term survival.
- This study investigates outcomes of bioprosthetic (BAVR) versus mechanical (MAVR) aortic valve replacement combined with coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate and compare the long-term survival and complication rates of bioprosthetic versus mechanical aortic valve replacement when performed concurrently with coronary artery bypass grafting.
Main Methods:
- A retrospective analysis of 750 patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) between 1984 and 1997.
- Patients received either bioprosthetic (BAVR, n=469) or mechanical (MAVR, n=281) aortic valves.
- Demographic and clinical data were collected to analyze early complications, operative mortality, and long-term survival.
Main Results:
- Operative mortality was 4.3% (BAVR 3.8%, MAVR 5.0%). Ten-year survival was 41.7% overall, with significantly lower observed survival for both BAVR (36%) and MAVR (48%) compared to predicted survival.
- Multivariable analysis identified age, perioperative infarction/stroke, non-elective surgery, and extent of coronary disease as predictors of early and late mortality. Valve type was not a significant predictor of late mortality.
- Ten-year freedom from structural deterioration and thromboembolism was similar between BAVR and MAVR. However, MAVR had significantly more anticoagulant bleeding complications (p < 0.005).
Conclusions:
- Combined AVR + CABG is associated with diminished long-term survival, irrespective of prosthetic valve type.
- While valve type did not predict late mortality, mechanical AVR was linked to worse survival outcomes and increased valve-related complications due to anticoagulation.
- Further research is needed to optimize surgical strategies and improve long-term outcomes for patients requiring combined AVR and CABG.
Background:
Concomitant coronary artery disease with aortic valve disease is an established risk factor for diminished late survival. This study evaluated the results of bioprosthetic (BAVR) or mechanical aortic valve replacement (MAVR) performed with coronary artery bypass grafting (CABG).
Methods:
From January 1984 through July 1997, combined AVR + CABG was performed in 750 consecutive patients; 469 received BAVR and 281 received MAVR. BAVR recipients were significantly older (mean age, 75 vs 65 years), and had more nonelective operations, congestive heart failure, peripheral vascular disease, preoperative intraaortic balloons, lower cardiac indices, more severe aortic stenosis, less aortic regurgitation, and more extensive coronary artery disease.
Results:
Early complications included operative mortality, 32 patients (4.3% total: 3.8% BAVR and 5.0% MAVR); perioperative infarction, 10 (1.3%); and perioperative stroke, 22 (2.9%). Significant multivariable predictors of early mortality were age, perioperative infarction or stroke, nonelective operation, operative year, ventricular hypertrophy, and need for intraaortic balloon. Ten-year actuarial survival was 41.7% for all patients. Predicted survival for age- and gender-matched cohorts from the general population versus observed survival were BAVR, 45% versus 36%; MAVR, 71% versus 48% (survival differences BAVR 9% vs MAVR 23%, p < 0.007). Significant multivariable predictors of late mortality included age, congestive failure, perioperative stroke, extent of coronary disease, peripheral vascular disease, and diabetes. Valve type was not significant. Ten-year actuarial freedom from valve-related complications were (BAVR vs MAVR) structural deterioration, 95% versus 100%, p = NS; thromboembolism, 86% versus 84%, p = NS; anticoagulant bleeding, 93% versus 88%, p < 0.005; reoperation, 98% versus 98%, p = NS.
Conclusions:
AVR + CABG has diminished late survival despite the type of prosthesis inserted. Although valve type did not predict late mortality, mechanical AVR was associated with worse survival compared with predicted and more valve-related complications due to anticoagulation requirements.
