Key result
Conventional AVR in patients with prior CABG carries ~5% 30-day mortality.
Why the study?
In patients with symptomatic aortic valve stenosis and previous CABG, interventional valve implantation may be superior but increased mortality and impaired survival with concomitant CAD remain concerns.
Does conventional aortic valve replacement surgery provide acceptable survival and quality of life in high-risk patients with symptomatic aortic valve stenosis and previous CABG?
Cohort (n=60)
Does conventional aortic valve replacement surgery provide acceptable survival and quality of life in high-risk patients with symptomatic aortic valve stenosis and previous CABG?
Conventional aortic valve replacement in high-risk patients with prior CABG and patent grafts yields acceptable 30-day mortality (5%) and good 5-year survival (69%), justifying its use despite surgical trauma.
OBJECTIVE: In patients with symptomatic aortic valve stenosis and a high estimated operative risk due to previous coronary artery bypass grafting (CABG) procedures, interventional aortic valve implantation techniques may ultimately prove superior. However, recent studies have revealed increased mortality and impaired survival in patients with concomitant coronary artery disease (CAD). METHODS: Between January 1996 and May 2010, 60 patients (73 ± 6 years, 15 female (25%)) underwent conventional operation 9 ± 6 years after CABG for symptomatic aortic valve stenosis (European System for Cardiac Operative Risk Evaluation, EuroSCORE) standard 11 ± 3%, logistic 27 ± 17%, Society of Thoracic Surgeons (STS) Score 19 ± 8%). Coronary angiography revealed open grafts and no need for further revascularization in all patients. High-risk patients were identified (log. EuroSCORE≥ 20%, n = 34) and divided by age (< 75 years, n=15; ≥ 75 years, n=19) for sub-group analysis. Follow-up for all 60 patients was performed according to the current guidelines: quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS: Thirty-day-mortality was 5% (n=3). During follow-up (100% complete), 18 patients died. Thus, 1-, 3- and 5-year survival was 91%, 77%, and 69%, respectively. No differences in survival could be detected between the two high-risk groups. Quality of life revealed excellent results for the entire cohort, as well as both high-risk groups. CONCLUSIONS: Conventional surgery in patients with symptomatic aortic valve stenosis after previous CABG can be performed with excellent results despite a high calculated risk, independent of age. Although conventional surgery is technically more demanding and associated with substantial surgical trauma, it is justified by the excellent survival and high quality of life in this high-risk patient cohort.
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Redlich et al. (2011) conducted a cohort in Symptomatic aortic valve stenosis with previous CABG (n=60). Conventional aortic valve replacement was evaluated on 30-day mortality. Conventional aortic valve replacement in patients with symptomatic aortic valve stenosis and previous CABG resulted in a 30-day mortality of 5% and a 5-year survival of 69%.
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