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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis

Jocelyn M Beach1, Tomislav Mihaljevic, Lars G Svensson

  • 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.

Journal of the American College of Cardiology
|February 23, 2013
PubMed

Insights

Patients with severe aortic stenosis and coronary artery disease undergoing both aortic valve replacement and coronary artery bypass grafting have poorer outcomes. Early intervention with AVR+CABG is recommended before myocardial damage occurs.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Coronary artery disease (CAD) is a common comorbidity in patients with severe aortic stenosis (AS).
  • The survival implications of concurrent CAD in severe AS patients are often underestimated.
  • Concurrent CAD can influence risk profiles and outcomes in patients undergoing aortic valve replacement (AVR).

Purpose of the Study:

  • To compare risk profiles and outcomes of patients with severe AS and CAD undergoing AVR plus coronary artery bypass grafting (AVR+CABG).
  • To contrast these outcomes with patients who have isolated severe AS undergoing AVR alone.
  • To identify shared and unique mortality risk factors in these patient groups.

Main Methods:

  • Retrospective analysis of 2,286 patients undergoing AVR+CABG and 1,637 undergoing AVR alone (October 1991 - July 2010).
  • Propensity score matching created 1,082 patient pairs for outcome comparison.
  • Long-term mortality analyses were performed to identify risk factors.

Main Results:

  • Patients with AS+CAD were older, more symptomatic, had lower ejection fraction, and greater arteriosclerotic burden but less severe AS.
  • AS+CAD patients experienced poorer hospital morbidity and 10-year survival (43% vs. 59%).
  • Early mortality in AS+CAD was linked to CAD; late mortality to left ventricular dysfunction. Optimal outcomes were seen in isolated AS with few comorbidities.

Conclusions:

  • Management of severe AS requires careful consideration of cardiovascular risk factors and comorbidities.
  • Patients with severe AS and concurrent CAD risk factors benefit from early diagnostics and AVR+CABG.
  • Intervention before ischemic myocardial damage is crucial for improving outcomes in AS+CAD patients.
Abstract

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