Basic Data From 176 Studies on the Immediate Outcome After Aortic Valve Replacement With or Without Coronary Artery Bypass Surgery

Biancari, Fausto; Martín, Marta Jiménez; Bordin, Giulia; Vettore, Elia; Vinco, Giulia; Anttila, Vesa; Airaksinen, Juhani; Vasques, Francesco

doi:10.1053/j.jvca.2013.07.020

Cited by 32 publications

(31 citation statements)

References 10 publications

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“…Early mortality of 4.9% after AVR combined with CABG is comparable with the previous reports [9,15]. It is increased as much as twice in high-risk patients defined if the Society of Thoracic Surgeon (STS) score is > 10% and/or European System for Cardiac Operative Risk Evaluation (Euro-SCORE) > 15% [16].…”

Section: Long-term Follow-upsupporting

confidence: 82%

Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter?

et al. 2018

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A b s t r a c tBackground: Aortic stenosis and coronary artery disease (CAD) sharing similar risk factors are associated with aging of the human population. Aim:The purpose of this study was to examine whether age affects clinical presentation, intraoperative management, and outcomes of patients who undergo simultaneous operations of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Methods:The study involved 452 consecutive patients aged 64.8 ± 8.2 years (range 38-79 years), who underwent combined AVR and CABG between 2005 and 2015. They were divided into three groups: Y (young; below the first quartile; n = 114), M (middle-aged; 58-71 years; n = 225) and E (elderly; above the third quartile; n = 113). Pre-and intraoperative variables were analysed. The deaths that occurred in hospital and throughout follow-up were defined as cardiac-or non-cardiac-related. The probability of survival was calculated with the use of Kaplan-Meier curves.Results: Coronary artery disease was more extensive in group E than in group Y (p < 0.05). Complete myocardial revascularisation was performed in 94.1%, 76.2%, and 62.8% in groups Y, M, and E, respectively (p < 0.05). In-hospital mortality was 2.0%, 5.3%, and 6.4%, in groups Y, M, and E, respectively. Early morbidity was significantly higher in group E than in groups M or Y. The 12-and 60-month freedom from cardiac-related death was higher in group Y (0.98 ± 0.02 and 0.94 ± 0.03) than in group E (0.93 ± 0.02 and 0.85 ± 0.03; p = 0.023, respectively). Left ventricular ejection fraction below 0.4 and incomplete revascularisation were associated with worse prognosis, particularly in group E. Conclusions:Elderly patients undergoing combined procedures of AVR and CABG having more extensive CAD less often receive complete revascularisation, are at higher risk of early organ failure, and present markedly reduced rates of freedom from cardiac-related deaths throughout follow-up than younger subjects.

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Section: Long-term Follow-upsupporting

confidence: 82%

Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter?

et al. 2018

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“…Our results do not support the hypothesis reported by other authors that high-risk patients requiring AVR and CABG should be the target of future treatment strategies such as endovascular and/or hybrid procedures. 22,23) The recent American Heart Association (AHA)/ American College of Cardiology (ACC) guidelines state that CABG is reasonable in patients undergoing valve repair or replacement with significant CAD (≥70% reduction in luminal diameter in major coronary arteries or ≥50% reduction in luminal diameter in the left main coronary artery). (Class 2A, Level of Evidence: C).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent paper reporting basic data from 176 studies on the immediate outcome of after SAVR with or without CABG, stroke rate was 2.1% after isolated SAVR and 3% after SAVR associated with CABG. 22) Recently the PARTNER IA Trial showed rates of major stroke in SAVR arm at one and five years of 3.2%, and 11.3%, respectively. 24) A meta-analysis of randomized, clinical trials also confirmed a significantly higher incidence of stroke with TAVR compared with SAVR at a mean follow-up of 99 weeks.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Nicolini

Fortuna

Contini

et al. 2016

ATCS

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Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.

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“…In a recent meta-analysis involving data from 700 000 patients, operative and/or 30-day mortality after conventional AVR was found to be 3.8% in patients between 70 and 79 years of age and 6.1% in patients >80 years of age. 18 These data are in favor of the hypothesis that the 30-day mortality after TAVR in younger, lower-risk patients might be at least equal to the risk after conventional AVR. TAVR is clearly less invasive if the procedure is performed with a transfemoral approach, intubation and mechanical ventilation is not required, and the procedure can be performed without extracorporeal circulatory support.…”

Section: Moving Toward Lower-risk Patients: Circumstantial Evidence Fmentioning

confidence: 96%

“…The stroke rate is <5%, 16,17 and the likelihood of postoperative permanent conduction abnormalities is <8%. 18 As a result of all these improvements, 30-day mortality declined from up to 30% in 1960 to <3% in 2012, 11,[18][19][20][21][22] with life expectancy normalized after a successful AVR.…”

mentioning

confidence: 99%

Transcatheter Aortic Valve Replacement Indications Should be Expanded to Lower-Risk and Younger Patients

Haußig

Linke

2014

Circulation

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Basic Data From 176 Studies on the Immediate Outcome After Aortic Valve Replacement With or Without Coronary Artery Bypass Surgery

Cited by 32 publications

References 10 publications

Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter?

Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter?

Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

Transcatheter Aortic Valve Replacement Indications Should be Expanded to Lower-Risk and Younger Patients

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