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Management of mild to moderate aortic valve disease during coronary artery bypass grafting

Alsir A M Ahmed1, Alastair N J Graham, Deirdre Lovell

  • 1Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, UK. alsir@hotmail.com

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 23, 2003
PubMed

Insights

Patients with mild to moderate aortic valve disease undergoing coronary artery bypass grafting (CABG) may benefit more from valve replacement than repair. Valve replacement during CABG is a predictor of improved survival in these patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Disease
  • Aortic Valve Pathology

Background:

  • Long-term survival for patients with mild to moderate aortic valve disease undergoing coronary artery bypass grafting (CABG) without valve replacement is not well-established.
  • Understanding outcomes is crucial for guiding treatment decisions in this patient population.

Purpose of the Study:

  • To evaluate the long-term survival of patients with mild to moderate aortic valve disease who underwent CABG without concomitant aortic valve replacement.
  • To compare outcomes with patients who underwent combined CABG and aortic valve replacement (AVR).

Main Methods:

  • Retrospective review of medical records from June 1978 to December 1996.
  • Identified 40 patients with mild to moderate aortic valve disease undergoing CABG without AVR (study group) and 61 patients with severe aortic valve disease undergoing CABG with AVR (control group).
  • Analyzed preoperative and intraoperative gradients, valve inspection/repair rates, and survival data.

Main Results:

  • Survival was significantly better in the control group (severe disease with AVR) compared to the study group (mild/moderate disease without AVR).
  • Eleven patients (27.5%) in the study group required reoperation for AVR, with no operative mortality.
  • Multivariate analysis identified valve replacement at initial CABG as the sole predictor of survival (beta=0.586, P=0.038).

Conclusions:

  • Patients with mild to moderate aortic valve disease undergoing CABG may achieve better long-term outcomes with valve replacement rather than repair, inspection, or no intervention.
  • Valve replacement at the time of initial CABG is recommended for improved survival.
  • Factors like preoperative gradient, age, sex, and specific valve pathology did not predict survival in the study group.
Abstract

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