Should the Aortic Valve Be Replaced in Patients with Mild Aortic Stenosis Admitted for Coronary Surgery?

Abstract

Background: The question whether the aortic valve in patients with mild aortic stenosis undergoing coronary artery bypass grafting (CABG) should be replaced or left alone is still controversial.

Methods: Between 01/1995 and 03/2004, 38 patients (30 male, 8 female, mean age 70.9 ± 7.8 years) required redo AVR 7.1 ± 4.8 years after primary CABG, while 202 patients (125 male, 77 female, mean age 72.7 ± 7.8 years) underwent combined AVR and CABG (1.9 ± 0.8 grafts/patient). To evaluate the different approaches, the data of the redo-AVR group were compared with the data of a propensity-score matched group of AVR + CABG patients.

Results: All patients survived the procedure; the 30-day survival was 94.7 % in both groups. The 1- and 5-year survival rates were 94.7 % and 83.8 % in the AVR after CABG group, and 94.7 % and 86.9 % in the AVR + CABG group, respectively. The late mortality was 28.9 % in the AVR after CABG and 25 % in the AVR + CABG group. Statistically, significant differences regarding perioperative mortality and morbidity could not be detected, neither with nor without propensity score analysis.

Conclusion: Combined AVR and CABG in patients with coronary artery disease and mild to moderate aortic stenosis seems advisable in an institution with an equally low perioperative risk for both procedures, because the patient will need only one surgical procedure instead of undergoing surgery with all the associated risks twice.

coronary bypass surgery - aortic valve replacement - aortic valve stenosis - reoperation

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