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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 its management: influence on survival in patients undergoing aortic valve replacement

C J Mullany, L R Elveback, R L Frye

    Journal of the American College of Cardiology
    |July 1, 1987
    PubMed

    Insights

    Preoperative coronary angiography is crucial for patients undergoing aortic valve replacement, especially those over 50. Identifying coronary artery disease and performing bypass grafting improves long-term survival.

    Area of Science:

    • Cardiovascular Surgery
    • Interventional Cardiology

    Background:

    • Aortic valve replacement (AVR) is a common procedure for severe aortic valve disease.
    • Coronary artery disease (CAD) frequently coexists with aortic valve disease, impacting surgical outcomes.
    • The role of preoperative coronary angiography and concurrent bypass grafting in AVR patients has evolved.

    Purpose of the Study:

    • To evaluate the impact of preoperative coronary angiography and bypass grafting on operative mortality and long-term survival in patients undergoing AVR.
    • To compare outcomes between patients with and without diagnosed CAD, and those who did or did not receive bypass grafting.
    • To assess changes in practice and outcomes over time.

    Main Methods:

    • Retrospective review of 1,156 patients (≥30 years) undergoing AVR (1967-1976, early series) and 227 patients (1982-1983, late series).
    • Patients were categorized based on preoperative coronary arteriography and presence/treatment of CAD (Group 1A: no CAD; Group 1B: CAD, no bypass; Group 1C: CAD, with bypass; Group 2: no arteriography).
    • Operative mortality (30-day) and 10-year survival rates were analyzed.

    Main Results:

    • In the early series, 10-year survival was 54% for all patients. Survival varied significantly by group: 63% (1A), 36% (1B), and 49% (1C).
    • Operative mortality rates were comparable across groups in the early series (4.5-10.3%).
    • In the late series, with increased angiography use (90%), operative mortality was lower: 1.4% (1A), 9.4% (1B), and 4.0% (1C).

    Conclusions:

    • Preoperative coronary angiography is essential for patients ≥50 years undergoing AVR to define coronary anatomy.
    • Bypass grafting is recommended for patients with significant CAD undergoing AVR, as it improves long-term survival.
    • The data suggest a shift towards more comprehensive evaluation and treatment of CAD in AVR patients over time.

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