Key result
Concomitant CABG during AVR is linked to ~95% higher hospital mortality but similar long-term survival.
Why the study?
Does combining CABG with aortic valve replacement affect survival and quality of life in patients over 70 years old compared to isolated aortic valve replacement?
Cohort (n=520)
Yes
Does combining CABG with aortic valve replacement affect survival and quality of life in patients over 70 years old compared to isolated aortic valve replacement?
Absolute Event Rate: 15.2% vs 7.8%
p-value: p=0.019
In elderly patients undergoing aortic valve replacement, concomitant CABG increases hospital mortality but does not negatively impact long-term survival or quality of life among survivors.
Concomitant CABG may raise perioperative mortality in elderly AVR patients; leaves open optimal selective use pending randomized trials.
Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians.Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed.Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains).Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG.
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Vicchio et al. (2012) conducted a cohort in Aortic valve stenosis (n=520). Coronary artery bypass grafting associated with aortic valve replacement vs. Isolated aortic valve replacement was evaluated on Hospital mortality (p=0.019). Associated coronary artery bypass grafting significantly increased hospital mortality (15.2% vs 7.8%) in elderly patients undergoing aortic valve replacement, but did not affect long-term survival or quality of life among survivors.
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