Evaluation of combined homograft replacement of aortic valve and coronary bypass grafting in patients with aortic stenosis.

Between January 1972 and October 1977, 40 patients with aortic stenosis underwent combined homograft replacement of the aortic valve and coronary artery bypass grafting.There were 29 men and 11 women between the ages of 38 years and 69 years (mean 58 years).Twenty-nine patients (73%) were in class III or IV ofthe NYHA Classification at the time of operation.Peak systolic aortic valve gradients ranged from 30 to 150 mmHg (mean 77 mmHg).Twelve patients (30%) had triple vessel disease, 13 (33%) had double vessel disease, and 15 (37%) had single vessel disease.Left main stem stenosis was present in four (10%).Altogether 59 grafts were inserted (average 1-5 grafts per patient).There were one early death (2.5%) and two late deaths (5%) during a follow-up between six and 62 months (mean 26 months).Thirty-three patients (89%) moved to class I of the NYHA Classification after operation.Four patients (10%) sustained perioperative infarction without deterioration in clinical status.Nineteen patients were reinvestigated by repeat left ventriculography and by graft and coronary angiography between three and 31 months (mean 12 months) after operation.The overall graft patency rate was 92 per cent.Left ventricular function was assessed by computerised radial analysis of segmental wall motion.Abnormalities of segmental wall motion in 12 patients were improved in eight (75%).All these patients had patent grafts.Deterioration in segmental wall motion occurred in two patients (17%) and was associated with graft occlusion in one and myocardial infarction in the other.In two patients abnormalities of segmental wall motion persisted.Both of these patients had had a myocardial infarction before operation.Combined homograft replacement of the aortic valve and coronary artery bypass grafting gives good clinical results, with a low early and late mortality.Improvement in left ventricular function occurs in the majority of patients.Coronary artery disease not uncommonly occurs in patients with aortic stenosis, with a reported incidence varying between 22 and 64 per cent (Basta et al., 1975; Harris et al., 1975; Mandal and Gray, 1976; Moraski et al., 1976; Paquay et al., 1976; Hancock, 1977; Thompson et al., 1979a).Pre- vious studies have shown that isolated valve replace- ment in such patients may be associated with a high mortality both early and late (Linhart and Wheat, 1967; Linhart et al., 1968).The influence of ad- ditional coronary artery bypass grafting on late prognosis and the prevention of myocardial infarc- tion still remains uncertain.The purpose of this paper is to analyse the early and long-term results "Supported in part by the British Heart Foundation.