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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Aortic valve replacement for aortic stenosis after previous coronary artery bypass grafting: could early reoperation

Jean Ph Verhoye1, Franceseca Merlicco, Ibrahim M Sami

  • 1Department of Thoracic and Cardiovascular Surgery, University Hospital, Ponchaillou, Rennes, France. jean-philippe.verhoye@chu-rennes.fr

The Journal of Heart Valve Disease
|August 12, 2006
PubMed

Insights

Aortic valve replacement (AVR) after coronary artery bypass graft (CABG) surgery carries high mortality if performed within five years. Consider AVR during CABG for select patients to improve outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Disease
  • Aortic Stenosis Management

Background:

  • Coronary artery bypass graft (CABG) surgery is often performed in patients with concomitant aortic stenosis (AS).
  • The optimal timing for aortic valve replacement (AVR) in patients who have undergone prior CABG is not well-defined.
  • Previous studies have not fully elucidated the risks associated with accelerated AS progression and outcomes after AVR in this patient cohort.

Purpose of the Study:

  • To retrospectively investigate the risk of accelerated aortic stenosis (AS) progression.
  • To evaluate the outcomes following aortic valve replacement (AVR) in patients with prior coronary artery bypass graft (CABG) surgery.
  • To identify predictors for AVR within five years of CABG.

Main Methods:

  • Retrospective analysis of 81 patients who underwent AVR for mild-to-moderate AS after initial CABG between 1994 and 2004.
  • Patients were stratified into three groups based on the time interval between CABG and AVR: <5 years, 5-10 years, and >10 years.
  • Multivariate analysis was employed to identify independent predictors of AVR timing and operative mortality.

Main Results:

  • Overall operative mortality after AVR was 16%, with significantly higher rates (30%) in patients undergoing AVR within five years of CABG.
  • Independent predictors for AVR within five years included a peak transvalvular gradient ≥30 mmHg, moderate calcifications with limited valve motion, and left ventricular hypertrophy (LVH).
  • Systemic vascular atherosclerotic disease predicted rapid AS progression and was a predictor of operative mortality.

Conclusions:

  • Due to high mortality associated with early repeat operations, AVR should be considered concurrently with CABG in select patients.
  • Recommended patient profile for concurrent AVR includes age ≤75 years, peak transvalvular gradient >30 mmHg, moderate calcifications with limited valve motion, and LVH.
  • This approach may mitigate risks associated with accelerated AS progression and improve long-term outcomes in patients requiring both procedures.
Abstract

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