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Aortic valve replacement after previous coronary artery bypass grafting
J A Odell1, C J Mullany, H V Schaff
1Division of Cardiothoracic Surgery, Mayo Clinic and Foundation, Rochester, Minnesota.
The Annals of Thoracic Surgery
|November 1, 1996
Summary
Aortic valve replacement (AVR) after coronary artery bypass grafting (CABG) has higher mortality. Consider AVR during initial CABG for patients with moderate aortic valve disease to improve outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Valvular Heart Disease
Background:
- Aging populations necessitate aortic valve replacement (AVR) in patients with prior coronary artery bypass grafting (CABG).
- This study investigates AVR outcomes post-CABG and evaluates indications for concurrent valve intervention during initial myocardial revascularization.
Purpose of the Study:
- To analyze the outcomes of aortic valve replacement (AVR) performed after previous coronary artery bypass grafting (CABG).
- To identify potential indications for performing AVR during the initial myocardial revascularization procedure in patients with concurrent aortic valve disease.
Main Methods:
- Retrospective analysis of 145 patients undergoing AVR after CABG between 1975 and 1994.
- Data collected included patient demographics, prior procedures, operative details, and postoperative outcomes, including mortality and cerebrovascular accidents.
Main Results:
- Overall mortality for AVR after CABG was 16.6%. Procedures involving redo CABG with AVR or more complex operations had higher mortality rates (12% and 45%, respectively).
- Prolonged cross-clamp time was the only significant independent predictor of mortality on multivariate analysis.
- Factors associated with mortality included low ejection fraction, sternal reentry, operative complexity, and prolonged cross-clamp/bypass times.
Conclusions:
- Aortic valve replacement following prior CABG is associated with increased operative mortality compared to repeat CABG or isolated repeat AVR.
- Liberal criteria for AVR during initial CABG are recommended for patients with mild to moderate aortic valve disease undergoing coronary revascularization.