The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

Abstract

In aged population, the early and long-term outcomes of coronary revascularization (CABG) added to surgical aortic valve replacement (SAVR) compared to isolated SAVR (i-SAVR) are conflicting. To address this limitation, a meta-analysis comparing the early and late outcomes of SAVR plus CABG with i-SAVR was performed. Electronic databases from January 2000 to November 2021 were screened. Studies reporting early-term and long-term comparison between the two treatments in patients over 75 years were analyzed. The primary endpoints were in-hospital/30-day mortality and overall long-term survival. The pooled odd ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated for in-early outcome and long-term survival, respectively. Random-effect model was used in all analyses. Forty-four retrospective observational studies reporting on 74,560 patients (i-SAVR = 36,062; SAVR + CABG = 38,498) were included for comparison. The pooled analysis revealed that i-SAVR was significantly associated with lower rate of early mortality compared to SAVR plus CABG (OR = 0.70, 95% CI 0.66–0.75; p < 0.0001) and with lower incidence of postoperative acute renal failure (OR = 0.65; 95% CI 0.50–0.91; p = 0.02), need for dialysis (OR = 0.65; 95% CI 0.50–0.86; p = 0.002) and prolonged mechanical ventilation (OR = 0.57; 95% CI 0.42–0.77; p < 0.0001). Twenty-two studies reported data of long-term follow-up. No differences were reported between the two groups in long-term survival (HR = 0.95; 95% CI 0.87–1.03; p = 0.23). CABG added to SAVR is associated with worse early outcomes in terms of early mortality, postoperative acute renal failure, and prolonged mechanical ventilation. Long-term survival was comparable between the two treatments.

Rates and Predictors of Structural Valve Degeneration and Failure of Trifecta Bioprosthetic Valve Over a 5-year Follow-up Period: A Single-center Experience

“…Recent studies have shown that combined CABG with SAVR is associated with increased in-hospital mortality and complications[ 20 21 ] meanwhile, long-term survival was comparable between isolated SAVR versus combined CABG and SAVR. [ 22 ] A recent meta-analysis which included 74,560 from 44 retrospective studies concluded that isolated SAVR is associated with a lower rate of early mortality compared to SAVR with concomitant CABG, with OR = 0.70 (95% CI 0.66–0.75; P < 0.001). [ 22 ] In addition, concomitant CABG was associated with a higher incidence of renal failure, the need for renal replacement therapy, and prolonged mechanical ventilation.…”

“…[ 22 ] A recent meta-analysis which included 74,560 from 44 retrospective studies concluded that isolated SAVR is associated with a lower rate of early mortality compared to SAVR with concomitant CABG, with OR = 0.70 (95% CI 0.66–0.75; P < 0.001). [ 22 ] In addition, concomitant CABG was associated with a higher incidence of renal failure, the need for renal replacement therapy, and prolonged mechanical ventilation. This is an area of debate, however, with no randomized control trials available to date.…”

Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience

“…In a recent meta-analysis of 5382 octogenarian patients, Gallingani and colleagues found that late survival did not differ significantly between the two groups [8]. Furthermore, in another meta-analysis of retrospective observational studies comparing outcomes of patients undergoing AVR, D'Alessandro and colleagues found that AVR + CABG was associated with a significantly higher incidence of 30-day mortality, postoperative acute renal failure, need for dialysis, and prolonged mechanical ventilation as compared with AVR [9,10]. However, the reported results share limitations inherent to the retrospective design of the study and are limited by several unmeasured confounders, particularly since many of the octogenarians who underwent isolated AVR had their CAD treated percutaneously during the follow-up.…”