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Published on: March 26, 2018
Aortic Valve Replacement and Concomitant Multi-Vessel Coronary Artery Bypass: The Impact of Using the Bilateral
Muhyung Heo1, Myoung Young Kim2, Jun Ho Lee1
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Bilateral internal thoracic artery (BITA) use in aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) showed similar mortality to single internal thoracic artery (SITA) use. BITA may benefit low-risk patients with improved survival.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- The survival advantage of coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (BITA) is established.
- The role of BITA in combined aortic valve replacement (AVR) and CABG procedures remains understudied.
Purpose of the Study:
- To investigate the outcomes of concomitant AVR and CABG comparing BITA versus single internal thoracic artery (SITA) use.
- To evaluate the impact of BITA on survival and morbidity in patients undergoing combined AVR and CABG.
Main Methods:
- Retrospective review of 114 patients undergoing concomitant AVR and CABG.
- Exclusion of cases not using an internal thoracic artery or with fewer than two bypass grafts.
- Follow-up duration averaged 61.5 months.
Main Results:
- 74 patients (64.9%) received BITA, and 40 (35.1%) received SITA.
- No significant differences in postoperative mortality or morbidity between BITA and SITA groups.
- Multivariable analysis indicated age as a predictor of death, but BITA use was not an independent predictor (p=0.094).
- BITA demonstrated significantly better survival in low-risk patients (ejection fraction >45%, p=0.043).
Conclusions:
- BITA use in concomitant AVR and CABG does not increase mortality compared to SITA.
- While long-term survival benefits are inconclusive, BITA is a viable option for carefully selected low-risk patients.
Background:
The survival benefit of coronary artery bypass grafting (CABG) using the bilateral internal thoracic arteries (BITA) is well known; however, the role of BITA in concomitant aortic valve replacement (AVR) and CABG has not been studied.
Methods:
We retrospectively reviewed patients who underwent concomitant AVR and CABG. Cases not using an internal thoracic artery and less than 2 bypass grafts were excluded. We enrolled 114 patients in this study. The mean follow-up duration was 61.5±43.5 months.
Results:
Forty patients (35.1%) underwent CABG with a single internal thoracic artery (SITA) and 74 patients (64.9%) underwent CABG with BITA. The preoperative clinical characteristics were not significantly different between the 2 groups, with the exception of a higher prevalence of atrial fibrillation in the SITA group. Postoperative mortality and morbidity were not significantly higher in the BITA group than in the SITA group. In the univariable analysis, the survival of the BITA group was similar to that of the SITA group (p=0.157). Multivariable analysis showed that only mean age was a predictor of death (p=0.042), but using BITA was not an independent predictor (p=0.094). In low-risk patients whose preoperative ejection fraction was >45%, the survival of the BITA group was significantly better than that of the SITA group (p=0.043).
Conclusion:
BITA use in concomitant AVR and CABG showed no difference in mortality compared to using SITA. Although its impact on long-term survival was inconclusive, BITA use can be considered for low-risk patients.
