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Updated: Jun 26, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this
Nawid Khaladj1, Malakh Shrestha, Sven Peterss
1Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany.
Insights
Redo aortic valve replacement (AVR) after coronary artery bypass grafting (CABG) with open grafts yields excellent surgical results. The Society of Thoracic Surgeons (STS) Risk Calculator better predicts mortality than EuroSCORE in these high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Repair and Replacement
Background:
- High-risk patients often undergo evaluation for catheter-based aortic valve replacement (AVR).
- Risk stratification for these patients typically involves scores like the EuroSCORE or the Society of Thoracic Surgeons (STS) Risk Calculator (RC).
- Redo aortic valve replacement (AVR) in patients with prior coronary artery bypass grafting (CABG) presents unique challenges.
Purpose of the Study:
- To evaluate the surgical outcomes of isolated AVR performed via median sternotomy in patients with prior CABG and patent grafts.
- To compare the predictive accuracy of the standard EuroSCORE, logistic EuroSCORE, and STS RC for operative mortality in this specific patient cohort.
Main Methods:
- Retrospective analysis of 349 patients undergoing redo AVR between January 1996 and January 2008.
- Focus on 39 patients with prior CABG and patent grafts who underwent isolated AVR.
- Operative mortality was assessed using standard EuroSCORE, logistic EuroSCORE, and STS RC, with Receiver Operating Characteristic (ROC) analysis for predictive accuracy.
Main Results:
- The 30-day operative mortality was 5% (2 patients).
- Predicted mortality rates were 12% (standard EuroSCORE), 32% (logistic EuroSCORE), and 10% (STS RC).
- The STS RC demonstrated significantly better prediction of mortality compared to both EuroSCOREs (p=0.006).
Conclusions:
- Conventional redo AVR after CABG in patients with patent grafts can achieve excellent outcomes with lower mortality than predicted.
- The STS RC is a more accurate predictor of mortality in this population than the EuroSCORE.
- Results from newer catheter-based AVR techniques should be interpreted cautiously and not solely justified by comparisons with artificial risk scores.
Aim:
High-risk patients are currently being evaluated for various catheter-based aortic valve replacement (AVR) techniques. To identify an individual patient's risk, scores such as the EuroSCORE or STS risk calculator (RC) are used. The aim of the present study was to evaluate the surgical results in patients who underwent isolated AVR via a median re-sternotomy after prior CABG.
Patients And Methods:
Between 01/96 and 01/08, 349 patients underwent AVR as a redo procedure. One hundred and thirty patients had undergone previous CABG; in 39 patients (29 male, median age 75 (60-84)) preoperative coronary angiography revealed open grafts with no need for additional revascularization (30 had LIMA grafts). These patients underwent isolated AVR. Operative mortality was calculated using the standard and logistic EuroSCORE, and the STS RC.
Results:
Operative (30-day mortality) was 5% (2 patients). Mean calculated predicted mortality rates for the cohort were: 12+/-3% for the standard, and 32+/-21% for the logistic EuroSCORE, and 10+/-4% according to the STS RC. Receiver operated characteristics (ROC) analysis revealed 100% specificity for standard EuroSCOREs up to 12.5%, logistic EuroSCOREs up to 39.7% and up to 17.45% for STS RC, with a sensitivity of 69.5%, 75% and 97.2%, respectively. The STS RC showed significant better prediction of mortality than the EuroSCOREs (p=0.006).
Conclusions:
Conventional AVR as a redo procedure after CABG with patent grafts can be performed with excellent results and lower mortality than estimated. Results of newer catheter-based AVR approaches should not to be compared with artificial scores to justify high morbidity rates.
