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Aortic valve replacement without myocardial revascularization in patients with combined aortic valvular and coronary
Insights
Coronary artery bypass grafting (CABG) may not be routinely needed during aortic valve replacement (AVR) for patients with coronary artery disease (CAD). Outcomes were similar with or without CABG, suggesting careful patient selection is key.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) often coexists with aortic valve disease.
- The necessity of concurrent coronary artery bypass grafting (CABG) during aortic valve replacement (AVR) for patients with CAD is debated.
- Optimal surgical strategy for patients with both conditions requires further investigation.
Purpose of the Study:
- To evaluate the necessity of routine CABG in patients undergoing AVR with coexistent CAD.
- To compare outcomes of AVR with and without CABG in patients with CAD against those without CAD and published data.
Main Methods:
- Retrospective comparison of 55 patients with CAD undergoing AVR without CABG versus 142 patients without CAD undergoing AVR.
- Comparison with published data of AVR plus CABG in CAD patients.
- Analysis of operative mortality, operative infarction, recurrent angina, and long-term survival.
Main Results:
- Operative mortality was comparable between patients with CAD (4%) and without CAD (5%).
- Long-term survival at 3 years was similar (80% for CAD vs. 82% for non-CAD).
- Only 15% of CAD patients experienced recurrent angina, with 6% requiring later CABG.
Conclusions:
- Preoperative detection of CAD does not mandate routine CABG during AVR.
- AVR without CABG in selected CAD patients yields outcomes comparable to AVR with CABG.
- Further research should focus on patient selection criteria for combined procedures.
Abstract:
To test the hypothesis that coronary artery bypass grafting (CABG) is not routinely required in patients undergoing aortic valve replacement (AVR) who have coexistent coronary artery disease (CAD), we compared the results of operation in 55 consecutive symptomatic patients who had CAD and underwent AVR without CABG with results in another 142 patients without CAD who underwent AVR during the same period, and with published results from other centers in which CABG was used in patients with CAD who underwent AVR. Operative mortality was 4% in patients with CAD and 5% in patients without CAD. Late survival was not significantly different between the two groups when analyzed for the entire population (80% survival at 3 years in CAD patients, 82% for non-CAD patients), or for the subgroup of patients with aortic stenosis, aortic regurgitation or aortic stenosis plus regurgitation. Eight patients with CAD (15%) developed recurrent angina after AVR (mean follow-up 43 months); only three patients (6%) required CABG because of medically refractory angina (12-43 months). Operative mortality, operative infarction (9%), recurrent angina and long-term survival in patients with CAD after AVR were similar to those at other centers after AVR plus CABG. These data suggest that preoperative detection of CAD does not necessitate CABG in all patients at the time of AVR.