Results of concomitant aortic valve replacement and coronary artery bypass grafting in the VA population

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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

Bahaaldin Alsoufi1, Tara Karamlou, Matthew Slater

  • 1Division of Cardiothoracic Surgery of Portland VA Hospital, Oregon, USA. balsoufi@hotmail.com

The Journal of Heart Valve Disease
|February 17, 2006
PubMed

Insights

Combined aortic valve replacement and coronary artery bypass grafting surgery is linked to reduced survival. Pre-existing conditions like diabetes and peripheral vascular disease significantly impact patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Outcomes Research

Background:

  • Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is associated with increased mortality.
  • Understanding factors influencing survival after combined AVR/CABG is crucial for patient management.

Purpose of the Study:

  • To identify predictors of early and late mortality in patients undergoing combined AVR and CABG.
  • To analyze survival outcomes in a Veterans Affairs (VA) population.

Main Methods:

  • Retrospective review of 401 patients undergoing AVR between 1993-2003, with 249 having combined AVR/CABG.
  • Patients were categorized by primary surgical indication: aortic valve pathology, coronary artery disease, or both.
  • Univariate and multivariable hazard analyses were used to explore short- and long-term outcomes.

Main Results:

  • Overall operative mortality was 6.4%. Early mortality was associated with NYHA class IV, diabetes, bioprosthetic valve, and combined severe aortic and coronary disease.
  • Five-year survival was 62% overall, with variations across patient groups.
  • Late mortality was significantly associated with preoperative peripheral vascular disease (PVD) and cerebrovascular disease (CVD).

Conclusions:

  • Combined AVR/CABG independently predicts decreased survival.
  • Preoperative factors including diabetes, PVD, CVD, and NYHA functional status significantly affect survival.
  • Further research is needed on the impact of coronary artery disease severity and effective orifice area index (EOAI) on outcomes.
Abstract

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