Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?

Abstract

We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR-CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups consisting of 98 (65.3%), 20 (13.3%) and 32 (21.3%) patients, respectively. The AS group had more female patients, a higher mean angina class, older mean patient age, increased history of previous myocardial infarction (MI), and smaller valve size compared to other groups. No significant differences were observed among groups in the operative mortality for five or ten-year survival rates. Significant early mortality risk factors included cross-clamp and cardiopulmonary bypass (CBP) time, number of blood transfusion units, chronic obstructive pulmonary disease (COPD), intra-aortic balloon pump (IABP), inotropic drugs, and pacemaker use. Significant late mortality risk factors included intensive care unit (ICU) stay, IABP, stroke, and dialysis. The aortic valve pathology type in patients undergoing concomitant AVR-CABG does not adversely affect survival.

Impact of Smoking Status on Outcomes after Concomitant Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery

“…Overall, current smokers had a worse preoperative comorbid state and underwent longer operations than nonsmokers, factors which have been previously shown to be predictors of increased mortality. 4,6,[8][9][10][11][12][13] The presence of these factors should skew the current smoking group toward a greater incidence of early mortality, but this was not reflected in our data. This may be explained by the notable difference in age between current smokers, previous smokers, and nonsmokers in this study.…”

“…[4][5][6][7][8] Many risk factors have been identified for an increased mortality including age, diabetes mellitus, renal dysfunction, New York Heart Association (NYHA) class, poor left ventricular function, ischemic valve dysfunction, urgent operation, increased cross-clamp time and bypass time, blood transfusion, and prior cardiac surgery. 4,6,[8][9][10][11][12][13] Despite cigarette smoking being a powerful risk factor for coronary artery disease, myocardial infarction, and cardiac death, its effect on outcomes after combined CABG and AVR remains equivocal. Indeed studies indicate that smoking may predispose patients to increased mortality or serious postoperative complications after cardiac surgery, [14][15][16][17] particularly, in the elderly population.…”

Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.

“…The prevalence of obstructive CAD in patients of RHD is low and ranges between 4-14%. [23][24][25] In Pakistan study by Shaikh et al 21 The prevalence of CAD in patients of DVD is high which is related to advanced age, male gender and presence of coronary risk factors in these patients. Pathogenesis of DVD and CAD shares common mechanism because both involve a process including lipid deposition, inflammation and calcification.…”

Concomitant aortic valve replacement and coronary artery bypass grafting

“…1999 年が 13.3％，2004 年が 17.2％である 2) ことからも顕 著な増加傾向にあることがわかる． CABG と AVR の同時手術の成績については国内外より 多数の報告 がなされており，近年は手術成績が向上し てきている．しかし，CABG と AVR の同時手術の手術死 亡率は，単独 AVR (2.0～3.7％) 1,3,25,26) や単独 CABG (0.5～ 2.9％) 1,[27][28][29][30] に比較して，3.0～11.2％ と高い傾向にあ る．遠隔成績についても 5 年生存率は AVR 単独で 70～ 85％ 3,26) ，CABG 単独で 88～91％ 29,30) であるのに対し， CABG と AVR の同時手術では 46～78％ 3-5, 8-13, 15-21) 11,16,19)…”

“…9.4％ 3,12,14,17) ，80 歳以上で 6.0～10.3％ 8,18,21) と 80 歳以上 で死亡率が高い．Likosky らは AVR と CABG の同時手術 17) ． ・ 周術期心筋梗塞の発症率は 1.3～5.2％ 11,16,18) であり，有 意な危険因子として，術前低 EF 低下が挙げられてい る 16) ． ・ 術後の腎機能障害については 1.1～20.8％ 4,6,16,20) ，透析を 要する腎不全は 2.0～5.0％ 5,19) と報告されている．Smith らは高齢になるほど術後腎機能障害のリスクが高まると 報告している…”