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Does previous valve replacement affect short-term coronary artery bypass grafting outcomes? A population-based
Renxi Li1, Stephen J Huddleston2, Deyanira J Prastein3
1The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Insights
Coronary artery bypass grafting (CABG) is generally safe after prior valve replacement, but carries a higher risk of vascular complications. This study highlights the need for careful preoperative assessment in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Coronary artery disease (CAD) and valvular heart disease often coexist.
- Understanding outcomes of combined procedures is crucial.
- Limited data exists on prior valve replacement impacting coronary artery bypass grafting (CABG) outcomes.
Purpose of the Study:
- To examine in-hospital outcomes of CABG in patients with prior valve replacement.
- To compare outcomes between patients with and without previous valve surgery undergoing CABG.
Main Methods:
- Utilized the National Inpatient Sample (USA, Q4 2015-2020).
- Included adult patients undergoing isolated CABG.
- Employed 1:3 propensity-score matching to control for confounding factors.
Main Results:
- 514 patients with prior valve replacement were matched with 1588 controls.
- No significant differences in most in-hospital outcomes.
- Increased risk of vascular complications (1.75% vs 0.57%), longer length of stay, and higher hospital charges observed in the prior valve replacement group.
Conclusions:
- CABG is generally safe for patients with prior valve replacement regarding short-term outcomes.
- An elevated risk of vascular complications warrants attention.
- Findings aid preoperative risk stratification for CABG in patients with previous valve surgery.
Background:
Coronary artery disease (CAD) and valvular disease frequently coexist due to similar pathophysiology. Effort has been dedicated to comprehending the outcomes of concomitant coronary revascularization and valve replacement procedures. However, the understanding of how prior valve replacement affects the outcomes of coronary artery bypass grafting (CABG) remains limited. Thus, this study aimed to conduct a population-based examination of the in-hospital outcomes in patients with previous valve replacement in CABG.
Methods:
Patients who underwent CABG were identified in the National Inpatient Sample in the USA from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between patients with and without previous valve replacement. In-hospital postoperative outcomes were assessed.
Results:
There were 514 patients with previous valve replacement who underwent CABG, who were matched to 1588 out of 167,668 controls. After matching, patients with valve replacement had mostly comparable in-hospital outcomes except for a higher risk of vascular complications (1.75 % vs 0.57 %, p = 0.02), a longer length of stay (10.90 ± 7.04 days vs 9.95 ± 6.53 days, p = 0.01), and higher hospital charges (275,465 ± 229,088 US dollars vs 231,648 ± 189,938 US dollars, p < 0.01).
Conclusion:
For short-term outcomes, CABG is generally safe for patients who have undergone previous valve replacement, although there is an increased risk of vascular complications that may warrant additional attention. The findings of this study can be valuable for preoperative risk assessment of patients who have had valve replacement and are considering CABG.
