Concomitant CABG-procedures in elderly patients undergoing aortic valve replacement. An additional risk factor?

Area of Science:

• Cardiovascular Surgery
• Geriatric Cardiology
• Interventional Cardiology

Background:

• Elderly patients undergoing aortic valve replacement (AVR) frequently have coexisting coronary artery disease (CAD).
• The benefit of performing concurrent coronary artery bypass grafting (CABG) alongside AVR in this population remains a subject of debate.
• Some studies suggest isolated AVR may yield better outcomes in elderly patients with CAD.

Purpose of the Study:

• To evaluate the outcomes of AVR with or without concomitant CABG in patients aged 75 years and older.
• To specifically analyze outcomes in elderly patients with known CAD who underwent isolated AVR.
• To determine the impact of bypassing specific coronary artery stenoses on surgical results.

Main Methods:

• Retrospective analysis of 283 patients (≥75 years) undergoing AVR, with or without CABG.
• Patients were divided into AVR (n=166) and AVR+CABG (n=117) groups.
• Subgroup analysis included patients with known CAD undergoing isolated AVR (n=51) versus isolated aortic valve disease (n=115).

Main Results:

• The AVR+CABG group experienced significantly longer mechanical ventilation and ICU stays compared to the AVR group.
• In-hospital mortality and severe postoperative complications were comparable between the two main groups.
• Bypassing moderate left anterior descending (LAD) artery stenoses in the isolated AVR group significantly improved outcomes, unlike stenoses in the right coronary or circumflex arteries.

Conclusions:

• Concomitant CABG is not a predictor of poor surgical outcomes in elderly patients undergoing AVR.
• Bypass grafting for moderate LAD stenoses is crucial for favorable outcomes in elderly patients with AVR and CAD.
• Moderate stenoses in the right coronary or circumflex arteries may be managed conservatively, potentially with secondary catheter intervention.