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Published on: December 11, 2017
Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the
Kyriakos Spiliopoulos1,2, Dimitrios Magouliotis1, Ilias Angelis2
1Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece.
Insights
Mortality after combined valve replacement and coronary artery bypass grafting is higher in female and older patients. Preoperative atrial fibrillation and high EuroScore independently predict lower survival, necessitating tailored treatment strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Combined valve replacement (VR) and coronary artery bypass grafting (CABG) is a complex procedure for patients with concomitant valvular disease and coronary artery disease (CAD).
- Understanding factors influencing early and late mortality is crucial for optimizing treatment strategies and improving patient outcomes.
Purpose of the Study:
- To analyze parameters affecting early and late mortality following combined VR and CABG surgery.
- To evaluate the impact of patient demographics, preoperative conditions, and surgical factors on survival.
- To discuss findings in the context of current treatment strategies for high-risk patients.
Main Methods:
- Retrospective analysis of 294 patients undergoing combined VR (aortic, mitral, or double valve) and CABG surgery.
- Data collected from an institutional registry, including patient characteristics, surgical details, and follow-up information.
- Statistical analysis to identify predictors of hospital mortality and long-term survival.
Main Results:
- Overall hospital mortality (30-day) was 6.5%, significantly higher in female patients, those older than 70, with preoperative myocardial infarction, high EuroScore (>8), and postoperative hemodynamic instability.
- Cumulative survival at 7.6 years was 78.6%. Favorable determinants included male gender, age <70, sinus rhythm, normal renal function, lower EuroScore (<8), and use of internal thoracic artery.
- Multivariate analysis identified preoperative atrial fibrillation (HR: 2.1) and EuroScore > 8 (HR: 3.63) as independent predictors of reduced long-term survival.
Conclusions:
- Hospital mortality is nearly 2.5-fold higher in female and/or elderly patients (>70 years).
- Preoperative atrial fibrillation and a high EuroScore (>8) are significant independent risk factors for late mortality after combined VR and CABG.
- Personalized treatment approaches, including newer techniques and hybrid procedures, are essential for favorable outcomes, particularly in high-risk individuals.
Objective:
The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives.
Methods:
The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery.
Results:
There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival.
Conclusions:
Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.
