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Aortic valve replacement with combined myocardial revascularisation
M Jones1, P M Schofield, N H Brooks
1Regional Cardiac Centre, Wythenshawe Hospital, Manchester.
Insights
Aortic valve replacement outcomes are affected by coronary artery disease. Myocardial revascularization improves survival rates for patients with both aortic valve and coronary artery disease, similar to those with isolated aortic valve disease.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
- The impact of concurrent coronary artery disease (CAD) on AVR outcomes requires further elucidation.
Purpose of the Study:
- To evaluate the early and late outcomes of AVR in patients with and without significant coronary artery disease.
- To assess the effect of myocardial revascularization (MR) on survival in patients undergoing AVR with CAD.
Main Methods:
- Retrospective analysis of 630 patients undergoing AVR between 1974 and 1982.
- Patients were categorized into three groups: no significant CAD, CAD with coronary artery bypass grafting (CABG), and CAD without CABG.
- Comparison of early mortality (within 30 days) and 3-year survival rates across groups.
Main Results:
- Early mortality was significantly lower in patients without CAD (6%) compared to those with CAD (13% with CABG, 16% without CABG).
- Three-year survival was higher for patients without CAD (83%) than for those with CAD not undergoing CABG (62%), but similar to those who had CABG (76%).
- More recent operations correlated with lower operative mortality across all groups.
Conclusions:
- Coronary artery disease significantly increases the risk associated with aortic valve replacement, irrespective of concurrent coronary artery bypass grafting.
- Myocardial revascularization appears to mitigate the adverse survival impact of coronary artery disease in patients undergoing aortic valve replacement, restoring survival rates comparable to those with isolated aortic valve disease.
Abstract:
Early and late outcome was studied in 630 patients who underwent aortic valve replacement between 1974 and 1982. Group 1 (506 patients) did not have important coronary artery disease, group 2 (69 patients) had coronary artery disease and underwent coronary artery bypass grafting, and group 3 (55 patients) had coronary artery disease but did not undergo myocardial revascularisation. Early mortality (within 30 days of operation) was significantly lower for group 1 (6%) than for group 2 (13%) and for group 3 (16%). Operative mortality in all three groups was lower in patients operated on more recently. The three year survival of patients in group 1 (83%) was significantly higher than that of patients in group 3 (62%) but not than that of patients in group 2 (76%). The findings of this study suggest that the presence of coronary artery disease increases the risk of aortic valve replacement whether or not coronary artery grafting is performed. Myocardial revascularisation, however, seems to return patients with aortic valve and coronary artery disease to a survival curve similar to that of patients with isolated aortic valve disease.