Aortic Valve Replacement With and Without Coronary Artery Bypass Surgery

Twenty-eight patients who underwent aortic valve replacement and coronary artery bypass grafts (group A) were compared, with respect to clinical presentation, operative mortality and morbidity and follow-up clinical status, with 40 patients who had normal coronary arteriograms and underwent aortic valve replacement only (group B). Groups A and B had a similar incidence of angina pectoris, cardiomegaly, and radiographic evidence of congestive heart failure prior to operation. Group A had a higher incidence of positive history of congestive heart failure, electrocardiographic changes indicative of an old myocardial infarction, and pure aortic regurgitation or mixed aortic stenosis-aortic regurgitation. In patients with pure aortic stenosis, the aortic valve area was greater and the aortic valve gradient was lower when there was associated coronary artery disease. The operative mortality was 14.3% in group A; 0% in group B. Postoperative morbidity was similar, except for a higher incidence of perioperative myocardial infarction in group A (10.7% vs 0%). There have been no late deaths in group A; four in group B. In the survivors, 23 of 24 group A and 36 of 36 group B patients are in NYHA class I or II, with good relief of symptoms. We conclude that the diagnosis of coronary artery disease in aortic valve disease is difficult to make without coronary arteriography. Combined aortic valve replacement and coronary artery bypass graft surgery carries a higher operative mortality than aortic valve replacement or coronary artery bypass graft surgery alone, but the clinical results at 1-3 year follow-up are equally satisfactory.