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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Outcomes after aortic valve replacement for aortic valve stenosis, with or without concomitant coronary artery bypass

Reo Sakakura1, Tohru Asai2, Tomoaki Suzuki1

  • 1Division of Cardiovascular Surgery, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan.

General Thoracic and Cardiovascular Surgery
|December 19, 2018
PubMed

Insights

Adding coronary artery bypass grafting (CABG) during aortic valve replacement (AVR) for aortic stenosis (AS) did not increase early or mid-term mortality. This finding is crucial for treatment strategy decisions in patients with AS requiring both procedures.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Aortic Valve Disease

Background:

  • Aortic stenosis (AS) is a significant valvular heart disease.
  • Aortic valve replacement (AVR) is the standard treatment for severe AS.
  • Concomitant coronary artery bypass grafting (CABG) is often considered in patients with AS and coronary artery disease.

Purpose of the Study:

  • To evaluate the impact of concomitant coronary artery bypass grafting (CABG) on outcomes after aortic valve replacement (AVR) for aortic stenosis (AS).
  • To compare morbidity and mortality between isolated AVR and combined AVR with CABG.

Main Methods:

  • A retrospective analysis of 605 patients who underwent AVR for AS between 2002 and 2014.
  • Patients were divided into two groups: isolated AVR (n=275) and AVR with concomitant CABG (n=122).
  • Multivariate and Kaplan-Meier analyses were used to assess mortality and morbidity.

Main Results:

  • No significant difference in 30-day mortality (1.5% vs. 0.8%) or post-discharge survival was observed between the groups.
  • Concomitant CABG was not associated with increased in-hospital or mid-term mortality.
  • Operative morbidities, including stroke, prolonged ventilation, deep sternal infection, and acute renal failure, were comparable between the isolated AVR and combined AVR with CABG groups.

Conclusions:

  • Performing concomitant CABG during AVR for AS does not increase early- or mid-term mortality.
  • The absence of increased risk with combined procedures should be considered when selecting treatment strategies for patients with AS and coronary artery disease.
Abstract

Keywords:
Aortic valve replacementAortic valve stenosisCoronary artery bypass graftingCoronary artery disease

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