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Management of patients with mild aortic stenosis undergoing coronary artery bypass grafting
J W Tam1, R G Masters, I G Burwash
1University of Ottawa Heart Institute, Ontario, Canada.
Insights
Routine aortic valve replacement is not necessary for patients with mild aortic stenosis undergoing coronary artery bypass grafting. However, valve replacement may be beneficial for those with higher gradients and calcified valves.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Aortic Stenosis Management
Background:
- Management of mild aortic stenosis during coronary artery bypass grafting (CABG) is debated.
- Identifying optimal surgical strategies is crucial for patient outcomes.
Purpose of the Study:
- To compare outcomes of isolated CABG versus combined CABG and aortic valve replacement (AVR) in patients with mild aortic stenosis.
- To identify predictors of disease progression in mild aortic stenosis.
Main Methods:
- Retrospective review of 70 patients with mild aortic stenosis from 1977-1994.
- Group A: isolated CABG (n=51); Group B: CABG + AVR (n=19).
- Exclusion of patients with moderate aortic regurgitation; assessment of valve calcification and cusp mobility via angiography.
Main Results:
- No significant difference in event-free survival between groups after age adjustment.
- Group A: 11 deaths, 8 subsequent AVRs; Group B: 5 deaths, 3 prosthetic valve complications.
- Initial transvalvular gradient and valve calcification predicted progression to severe aortic stenosis in Group A.
Conclusions:
- Routine AVR is not indicated for mild aortic stenosis during CABG.
- Concomitant AVR may be considered for patients with high transvalvular gradients and calcified aortic valves.
Background:
The management of mild aortic stenosis during coronary artery bypass grafting remains controversial.
Methods:
We reviewed the medical records of consecutive patients between January 1, 1977, and December 31, 1994, to identify 51 patients with mild aortic stenosis who underwent isolated coronary artery bypass grafting (group A), and 19 patients with mild aortic stenosis who underwent combined coronary artery bypass grafting and aortic valve replacement (group B). Patients with more than moderate aortic regurgitation were excluded. Preoperative angiograms were reviewed to assess the severity of calcification and restricted mobility of the aortic cusps.
Results:
In group A there were 11 deaths and 8 subsequent aortic valve replacements; in group B there were 5 deaths and 3 prosthetic valve-related complications. There was no difference in event-free survival between the two groups after adjusting for the difference in age. Among group A patients, the initial transvalvular gradient (p = 0.0005) and aortic valvular calcification (p = 0.06) identified patients who demonstrated progression to severe aortic stenosis during follow-up.
Conclusions:
Our data suggest that routine aortic valve replacement during coronary artery bypass grafting in patients with mild aortic stenosis is not indicated, but concomitant aortic valve replacement may be appropriate in patients with higher transvalvular gradients and calcified valves.