Impact of Coronary Disease after Aortic Valve Replacement

Left ventricular dimensions tend to reduce after aortic valve replacement in patients with aortic stenosis. Whether concomitant coronary artery disease has an influence on postoperative ventricular dimensions has not been evaluated. Between 1998 and 2002, 112 patients underwent aortic valve replacement for aortic stenosis; 68 had isolated aortic valve replacement, and 44 had combined coronary artery bypass grafting. Left ventricular dimensions were assessed by echocardiography preoperatively and at 3 and 12 months postoperatively. Transvalvular mean gradient, left ventricular end-diastolic diameter, and left ventricular mass index decreased significantly postoperatively, while left ventricular ejection fraction improved. Preoperative left ventricular dimensions in patients with isolated aortic stenosis were worse than in those with aortic stenosis and coronary artery disease. After aortic valve replacement with coronary artery bypass, left ventricular mass index regression was less than that after valve replacement alone, and there was no improvement in ejection fraction. This suggests that coronary artery disease has a negative impact on postoperative myocardial recovery.