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[Prognosis after aortic valve replacement for aortic valve stenosis with or without associated coronary lesions]
B Iung1, P L Michel, O de Pamphilis
1Service de cardiologie, hôpital Tenon, Paris.
Insights
Combined aortic valve and coronary surgery for aortic stenosis with coronary artery disease shows higher perioperative infarction rates but similar long-term survival compared to isolated aortic valve replacement.
Area of Science:
- Cardiovascular Surgery
- Cardiac Pathology
- Geriatric Cardiology
Context:
- Increasing prevalence of aortic stenosis (AS) and coronary artery disease in aging populations.
- Equivocal outcomes reported for combined valve and coronary surgery versus isolated aortic valve replacement.
- Need for comparative analysis of combined surgical approach risks and benefits.
Purpose:
- To compare the outcomes of combined aortic valve replacement and coronary artery bypass grafting (CABG) with isolated aortic valve replacement (AVR) in patients with AS.
- To assess operative mortality, perioperative infarction rates, and long-term survival.
- To evaluate the safety and efficacy of combined surgical procedures in a paired patient cohort.
Summary:
- A study compared 122 patients undergoing combined AVR+CABG (Group I) with 122 patients undergoing isolated AVR (Group II), matched for key prognostic factors.
- Group I exhibited higher operative mortality (10.6% vs. 4.9%) and significantly increased perioperative infarction rates (6.6% vs. 0.8%).
- Seven-year actuarial survival rates were comparable between groups (71.8% vs. 74.9%), with no increased late mortality in the combined surgery group.
Impact:
- Findings suggest combined surgery for AS and coronary disease carries higher short-term risks, particularly perioperative infarction.
- Long-term survival is not adversely affected by combined procedures, indicating potential benefit despite initial risks.
- Results inform clinical decision-making regarding surgical management strategies for complex cardiac patients.
Abstract:
With the increasing age of patients and the progression of degenerative pathologies, the management of aortic stenosis (AS) with coronary artery disease is becoming more frequent. Reported results of combined valve and coronary surgery are equivocal especially with respect to the increased risk compared with aortic valve replacement without coronary surgery. The authors assessed the results of combined surgery by comparing two groups of patients with AS operated between 1979 and 1991: 122 patients with coronary lesions undergoing combined valve and coronary surgery (Group I) and 122 patients without coronary artery disease undergoing isolated aortic valve replacement (Group II) and paired with Group I patients for 5 prognostic factors (age, sex, functional status, date of surgery and left ventricular ejection fraction). Pairing the patients provided comparable populations for these 5 factors. The average age was high (68 years in Group I with over 50% of patients over 70 years of age) and most patients were in functional classes III or IV (67% in Group I). In Group I, 67% of patients had multivessel disease (average 2 vessel disease). Aortic valve replacement was associated with an average of 1.7 coronary bypass grafts per patient. Myocardial protection was the same in all cases using cold potassium enriched cardioplegic solutions. Operative mortality was 10.6% in Group I compared with 4.9% in Group II (NS) and the respective perioperative infarction rates were 6.6% and 0.8% (p < 0.02). Seven year actuarial survival rates were 71.8% in Group I and 74.9% in Group II (NS) without any increased late mortality in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)