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Impact of coronary artery disease on valvular heart surgery
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio.
Insights
Coronary bypass grafting with aortic valve replacement has lower long-term survival. Porcine valves improve outcomes, while mitral valve surgery combined with bypass grafting shows poorer results, necessitating improved mitral valve reconstruction techniques.
Area of Science:
- Cardiac Surgery
- Cardiovascular Medicine
- Biomaterials in Medicine
Background:
- Combined coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) show improved in-hospital survival but inferior long-term outcomes compared to isolated AVR.
- Surgical outcomes for patients with combined coronary artery and mitral valve disease are complex due to evolving surgical techniques and diagnostics.
- Mitral valve surgery combined with CABG presents higher mortality and worse long-term survival than combined CABG and AVR.
Purpose of the Study:
- To compare the long-term survival and event-free survival of patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG).
- To evaluate the impact of valve type (porcine heterografts vs. mechanical valves) on late survival after combined AVR and CABG.
- To analyze the outcomes of mitral valve surgery combined with CABG and compare them to combined AVR and CABG procedures.
Main Methods:
- Retrospective analysis of patient data comparing outcomes based on surgical procedures (isolated AVR, combined AVR/CABG, combined mitral valve replacement/CABG).
- Comparison of survival rates and event-free survival between different valve prostheses (porcine heterografts vs. mechanical valves) in combined AVR/CABG.
- Assessment of in-hospital mortality and late survival trends for combined mitral valve surgery and CABG versus combined AVR and CABG.
Main Results:
- Patients undergoing combined AVR and CABG have inferior late survival compared to those undergoing isolated AVR.
- Porcine heterografts demonstrate superior late survival and event-free survival compared to mechanical valves after combined AVR and CABG.
- Combined mitral valve replacement and CABG is associated with higher in-hospital mortality and worse late survival than combined AVR and CABG.
Conclusions:
- While in-hospital mortality is low for combined CABG and AVR, long-term survival remains a concern.
- Porcine heterografts represent a favorable option for valve replacement in patients undergoing combined AVR and CABG.
- Advancements in mitral valve reconstruction techniques are crucial for improving long-term outcomes in patients with combined mitral valve disease and coronary artery disease.
Abstract:
Patients who undergo coronary bypass grafting in association with aortic valve replacement currently have a low in-hospital mortality, but their late survival is inferior to that of patients without coronary disease who undergo isolated aortic valve replacement. Patients who receive porcine heterografts to replace the aortic valve have better late survival and event-free survival after aortic valve replacement combined with bypass grafting than those who received mechanical valves. The analyses of patients who combine coronary artery and mitral valve disease is difficult because of changing surgical practices and diagnostic techniques. Patients undergoing surgery for mitral valve replacement combined with bypass grafting have had higher in-hospital mortality and worse late survival than patients undergoing aortic valve replacement combined with bypass grafting. The increased use of techniques for reconstructing rather than replacing the mitral valve may help improve the long-term results for patients undergoing surgery for mitral valve dysfunction combined with coronary disease.