[Reoperation for aortic valve replacement after myocardial revascularization]

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Valvular Heart Disease

Background:

• Patients undergoing coronary bypass surgery may have coexisting aortic stenosis (AS).
• The optimal management of insignificant AS during coronary bypass surgery remains debated.
• Reoperation for aortic valve replacement (AVR) carries specific risks in patients with prior cardiac surgery.

Purpose of the Study:

• To evaluate the outcomes of aortic valve replacement (AVR) in patients reoperated after previous aortocoronary bypass surgery.
• To assess the necessity of prophylactic AVR for insignificant aortic stenosis (AS) in patients undergoing coronary bypass surgery.
• To determine the optimal timing for AVR in patients with prior coronary bypass surgery.

Main Methods:

• Retrospective analysis of 13 patients (11 male, 2 female, mean age 61 years) who underwent reoperation for AVR after aortocoronary bypass surgery.
• Patients were divided into two groups: Group I (8 patients) with insignificant AS at initial bypass, and Group II (5 patients) with no valvular lesion.
• Follow-up averaged 3 years, assessing operative complications, mortality, and long-term outcomes.

Main Results:

• No sternotomy or adhesion dissection complications were observed; graft mobilization was required in 3 cases.
• A transverse low aortotomy facilitated successful AVR in all patients.
• One patient in Group II died postoperatively from low output syndrome; overall survival was 9/13 patients after follow-up, with 3 deaths in Group I.

Conclusions:

• Prophylactic AVR for insignificant AS during coronary bypass surgery is not justified.
• Regular echocardiographic monitoring is crucial for identifying the optimal time for AVR.
• Delayed AVR, even years after initial bypass, can be performed with acceptable operative risk.