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Impact of coronary artery bypass grafting on survival after aortic valve replacement

J Mark Jones1, Deidre Lovell, Gordon W Cran

  • 1Division of Cardiac, Vascular and Thoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK. mark.jones@royalhospitals.n-i.nhs.uk

Interactive Cardiovascular and Thoracic Surgery
|August 3, 2007
PubMed

Insights

Combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) shows comparable survival to isolated AVR, with left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery not significantly impacting outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mechanical Prosthetic Valves

Background:

  • Coronary artery disease (CAD) treatment with coronary artery bypass grafting (CABG) alongside aortic valve replacement (AVR) may improve outcomes.
  • The specific survival benefit of concurrent CABG with AVR, particularly using left internal mammary artery (LIMA) grafts, remains unclear compared to isolated AVR.

Purpose of the Study:

  • To evaluate the long-term survival outcomes of patients undergoing elective primary aortic valve replacement (AVR) with or without concurrent coronary artery bypass grafting (CABG).
  • To assess the impact of different CABG strategies, including left internal mammary artery (LIMA) to left anterior descending (LAD) grafting, on survival after AVR.

Main Methods:

  • Retrospective review of 799 patients undergoing elective primary AVR with a St. Jude mechanical prosthesis between March 1986 and May 2000.
  • Analysis included isolated AVR, AVR with CABG using LIMA to LAD, AVR with non-LAD vein grafts, and AVR with LAD vein grafts.
  • Survival analysis utilized Cox regression and multivariable regression models with 100% follow-up.

Main Results:

  • Operative mortality varied: 1.6% (isolated AVR), 2.6% (LIMA-AVR), 6.25% (Non-LAD VG-AVR), and 2.4% (LAD VG-AVR).
  • Cox regression showed improved survival after AVR compared to LAD VG-AVR (P=0.008), but no significant difference for LIMA-AVR (P=0.18) or Non-LAD VG-AVR (P=0.08).
  • Independent predictors of reduced survival included advanced age, male sex, absence of diabetes, number of grafts, non-congenital pathology, and regurgitant valve disease. LIMA-LAD grafting was not significant.

Conclusions:

  • Concurrent CABG with AVR does not significantly alter survival compared to isolated AVR, even with LIMA-LAD grafting.
  • Grafting strategy to the LAD using vein grafts may be associated with reduced survival compared to isolated AVR.
  • Patient factors like age, sex, and comorbidities are significant predictors of survival after AVR.

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