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Ten-year survival following aortic valve replacement: A multivariate analysis of coronary bypass as a risk factor
Insights
Combined aortic valve replacement and coronary bypass surgery showed similar operative mortality to valve replacement alone. Coronary artery disease requiring bypass surgery slightly decreased long-term survival in these patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Aortic Valve Replacement
Background:
- Aortic valve replacement (AVR) is a common procedure for severe aortic stenosis.
- Coronary artery disease (CAD) frequently coexists with aortic valve disease.
- The impact of concomitant coronary artery bypass grafting (CABG) on AVR outcomes requires evaluation.
Purpose of the Study:
- To analyze the additional risk associated with coronary bypass surgery in patients undergoing aortic valve replacement.
- To compare operative mortality and long-term survival between isolated AVR and combined AVR + CABG.
Main Methods:
- Retrospective analysis of 664 patients aged over 40 undergoing AVR between 1969 and 1981.
- Comparison of outcomes between 467 patients with isolated AVR and 197 patients with combined AVR and CABG.
- Multivariate analysis to identify factors affecting ten-year survival.
Main Results:
- Operative mortality was 9% for isolated AVR and 10% for combined AVR + CABG.
- Since 1976, operative mortality for combined procedures decreased to 5% and perioperative myocardial infarction to 2%.
- Ten-year survival was 56% for AVR alone and 49% for combined AVR + CABG. Age, functional class, and year of operation significantly impacted survival.
Conclusions:
- Combined AVR and CABG had comparable early operative mortality to isolated AVR.
- Coronary artery disease requiring CABG was associated with a trend towards decreased ten-year survival.
- Improvements in surgical techniques have reduced mortality and morbidity for combined procedures.
Abstract:
The additional risk of coronary bypass surgery was analysed in 664 patients over 40 years of age undergoing aortic valve replacement between 1969 and 1981. Four hundred sixty-seven patients underwent aortic valve replacement alone, while 197 patients with coronary artery disease underwent combined aortic valve replacement and coronary bypass surgery. There were no significant differences in the preoperative hemodynamic characteristics of the two groups of patients. There were 41 (9%) operative deaths following aortic valve replacement alone and 20 (10%) following aortic valve replacement with coronary bypass surgery. Since 1976, operative mortality has fallen to 5% and perioperative myocardial infarction to 2% following the combined procedure. Ten-year actuarial survival (standard error) was 56 (3%) following aortic valve replacement and 49 (6%) following aortic valve replacement and coronary bypass surgery. A multivariate analysis including both groups of patients revealed that age, functional class and year of operation significantly affected ten-year survival (p less than 0.05). The same analysis showed that coronary artery disease requiring coronary bypass surgery also decreased ten year survival in patients undergoing aortic valve replacement (p = 0.06).