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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting

G A de Waard1, E K Jansen, M de Mulder

  • 1Department of Cardiology, Medical Center Alkmaar, Alkmaar, the Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|February 8, 2012
PubMed

Insights

Combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery showed higher 5-year mortality than isolated AVR. However, only prior CABG, renal function, and age, not the combined procedure itself, were independent mortality risks.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Aortic Valve Disease

Background:

  • Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is associated with higher operative mortality than isolated AVR.
  • Long-term mortality outcomes for combined AVR and CABG remain conflicting in existing literature.

Purpose of the Study:

  • To prospectively compare the long-term outcomes and identify risk factors for mortality in patients undergoing isolated AVR versus combined AVR and CABG.
  • To analyze a consecutive Dutch patient cohort for comparative surgical outcomes.

Main Methods:

  • A prospective study included 332 patients undergoing AVR with or without CABG between 2001 and 2010.
  • Multivariate Cox proportional hazard analysis was used to identify independent risk factors for long-term mortality.

Main Results:

  • Five-year survival was 85% for isolated AVR and 73% for combined AVR and CABG (p=0.012).
  • Patients in the combined group were older with worse cardiac risk profiles and preoperative status.
  • Independent mortality predictors included higher creatinine, previous CABG, and increasing age.

Conclusions:

  • Concomitant AVR and CABG in unselected patients was associated with higher 5-year mortality compared to isolated AVR.
  • Prior CABG, renal function, and age were independently linked to increased mortality, but not the concomitant CABG procedure itself.
  • Observed mortality favorably compared with EuroSCORE risk assessment.
Abstract

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