Is myocardial revascularization really necessary in patients with ≥50% but <70% coronary stenosis undergoing valvular...

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Patients undergoing valvular surgery often present with moderate coronary artery stenosis.
• The necessity of coronary artery bypass grafting (CABG) in these patients is debated.
• Current guidelines may lead to overtreatment of coronary stenosis in this population.

Purpose of the Study:

• To evaluate the safety and efficacy of omitting coronary artery bypass grafting in patients with moderate coronary artery stenosis undergoing primary valvular surgery.
• To assess the immediate and mid-term clinical outcomes of this 'intentional omission strategy'.

Main Methods:

• A cohort of 77 patients with moderate coronary stenosis (50-70%) undergoing aortic or mitral valve surgery without prior symptoms of angina or ischemia were included.
• Coronary artery bypass grafting was intentionally omitted in all patients.
• Patients were followed for up to 6 years post-surgery.

Main Results:

• No in-hospital deaths occurred.
• Only one patient experienced postoperative acute myocardial infarction, treated successfully with percutaneous coronary intervention (PCI).
• The 6-year overall survival rate was 94.7%, with no cardiac deaths recorded. The cumulative incidence of PCI at 6 years was 8%.

Conclusions:

• Moderate coronary stenosis discovered incidentally during valvular surgery can often be safely managed without intervention.
• The 'intentional omission strategy' for CABG in selected patients undergoing valvular surgery is associated with favorable mid-term outcomes.
• This approach may be applicable to minimally invasive cardiac surgery, percutaneous procedures, and complex patient profiles.