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Reduction in sudden late death by concomitant revascularization with aortic valve replacement
L S Czer1, R J Gray, M E Stewart
1Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 1988
Summary
Coronary artery disease significantly reduces survival after aortic valve replacement, increasing early and late mortality. Myocardial revascularization improves outcomes and reduces sudden death risk without increasing operative risk.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Aortic Valve Replacement
Background:
- Coronary atherosclerosis is a common comorbidity in patients undergoing aortic valve replacement (AVR).
- The impact of concomitant coronary artery disease (CAD) and its treatment on survival after AVR is not fully elucidated.
Purpose of the Study:
- To evaluate the effect of coronary atherosclerosis and myocardial revascularization on early and late survival following isolated AVR.
- To identify predictors of mortality in patients undergoing AVR with and without CAD.
Main Methods:
- Retrospective review of 474 patients who underwent isolated AVR between 1969 and 1984.
- Patients were categorized into three groups: no CAD, coronary artery bypass grafting (CABG), and unbypassed CAD.
- Actuarial survival analysis and multivariate logistic regression were used to assess outcomes.
Main Results:
- Early mortality was higher in patients with CAD (8.2% with CABG, 7.1% unbypassed) compared to those without CAD (2.2%).
- Ten-year survival rates were significantly lower for patients with CAD (41% with CABG, 26% unbypassed) versus no CAD (77%).
- Advanced NYHA class, age, extent of CAD, and lack of cardioplegia predicted early death; CAD and reduced LVEF predicted late death. Revascularization did not increase operative risk.
Conclusions:
- Coexistent coronary atherosclerosis adversely affects both early and late survival after AVR.
- Myocardial revascularization in patients with CAD undergoing AVR does not increase operative risk and significantly reduces late sudden death.
- Strategies including cardioplegia and complete revascularization are recommended for patients with CAD undergoing AVR.