Safety of remote aortic valve replacement after prior coronary artery bypass grafting

A previous coronary artery bypass grafting (CABG) procedure may complicate subsequent aortic valve replacement (AVR). However, the operative risks and long-term outcome of patients who undergo these two procedures remain poorly defined.

The medical records of all patients undergoing AVR between February 1986 and September 1995 were reviewed retrospectively. The patients selected for analysis had previously undergone CABG.

We performed AVR in 23 consecutive patients who had previously undergone CABG (mean number of grafts, 2.8). The AVR was performed an average of 7.6 years after CABG (range, 2 to 17 years). There were 20 men and 3 women, with a mean age of 69 years (range, 56 to 85 years). Twenty patients were operated upon for aortic stenosis (mean gradient 54 mm Hg, mean valve area 0.7 cm2), and 3 patients underwent operation for aortic regurgitation. The average aortic valve gradient at the initial revascularization operation was 8 mm Hg (range, 0 to 29 mm Hg). There was no correlation between the aortic valve gradient at the initial revascularization and the interval between CABG and AVR. At the second operation, AVR was performed alone in 11 patients, combined with repeat CABG in 11 patients (mean number of grafts, 1.4), and with mitral valve replacement in 1 patient. A mechanical prosthesis was selected in 14 patients, and a bioprosthesis was used in 9 patients. There were no perioperative deaths. There were five late deaths at an average follow-up of 44 months. The 5-year actuarial survival was 71%.

Previous CABG poses added technical challenges at the time of reoperation for AVR. The operation can be performed safely, with the expectation of satisfactory long-term survival.