Netherlands Heart Journal

, Volume 20, Issue 3, pp 110–117 | Cite as

Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting

  • G. A. de Waard
  • E. K. Jansen
  • M. de Mulder
  • A. B. A. Vonk
  • V. A. Umans
Original article

Abstract

Background

It is well established that concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) has a higher operative mortality rate than isolated AVR. However, studies report conflicting results on the long-term mortality. The aim of this prospective study was to explore and compare the outcomes and risk factors of isolated AVR and concomitant AVR and CABG in a consecutive Dutch patient population.

Methods

From January 2001 through January 2010, 332 consecutive patients underwent AVR with or without CABG at a single institution (197 isolated AVR and 135 concomitant AVR and CABG). A multivariate Cox proportional hazard analysis was performed to determine the independent risk factors for long-term mortality after aortic valve replacement.

Results

All 332 consecutive, referred patients who underwent aortic valve surgery were followed for up to 10 years. Median follow-up length was 48 months. The population had a median age of 73 years (IQR 65–78) and predominantly consisted of males (62%). Patients in the combined AVR and CABG group were older, had worse cardiac risk profiles and had worse preoperative cardiac statuses than those receiving isolated AVR. Five-year survival was 85% in AVR and 73% in AVR-CABG (p-value 0.012). Independent risk factors for mortality were higher creatinine values, previous CABG and increasing age.

Conclusion

Unselected, consecutive patients who underwent aortic valve replacement surgery and who received concomitant bypass surgery between 2001–2010 had higher 5-year mortality than their counterparts without CABG. Prior CABG, renal function, age but not concomitant CABG remained independently associated with increased mortality. Finally, the observed mortality rate in this consecutive patient group compared favourably with preoperative risk assessment using the EuroSCORE.

Keywords

Aortic valve replacement Coronary artery bypass grafting Long term Outcome Survival EuroSCORE Concomitant Valve Surgery AVR CABG 

References

  1. 1.
    Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1–coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1 Suppl):S2–S22.PubMedCrossRefGoogle Scholar
  2. 2.
    O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2–isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Shahian DM, O’Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3–valve plus coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1 Suppl):S43–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Ambler G, Omar RZ, Royston P, et al. Generic, simple risk stratification model for heart valve surgery. Circulation. 2005;112(2):224–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Roques F, Michel P, Goldstone AR, et al. The logistic EuroSCORE. Eur Heart J. 2003;24(9):881–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Jones JM, Lovell D, Cran GW, et al. Impact of coronary artery bypass grafting on survival after aortic valve replacement. Interact Cardiovasc Thorac Surg. 2006;5(3):327–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Kvidal P, Bergstrom R, Horte LG, et al. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35(3):747–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Melby SJ, Zierer A, Kaiser SP, et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg. 2007;83(5):1651–6.PubMedCrossRefGoogle Scholar
  9. 9.
    He GW, Grunkemeier GL, Starr A. Aortic valve replacement in elderly patients: influence of concomitant coronary grafting on late survival. Ann Thorac Surg. 1996;61(6):1746–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Grossi EA, Schwartz CF, Yu PJ, et al. High-risk aortic valve replacement: are the outcomes as bad as predicted? Ann Thorac Surg. 2008;85(1):102–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown ML, Schaff HV, Sarano ME, et al. Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement? J Thorac Cardiovasc Surg. 2008;136(3):566–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Gummert JF, Funkat A, Osswald B, et al. EuroSCORE overestimates the risk of cardiac surgery: results from the national registry of the German Society of Thoracic and Cardiovascular Surgery. Clin Res Cardiol. 2009;98(6):363–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Bhatti F, Grayson AD, Grotte G, et al. The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk? Heart. 2006;92(12):1817–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Chikwe J, Croft LB, Goldstone AB, et al. Comparison of the results of aortic valve replacement with or without concomitant coronary artery bypass grafting in patients with left ventricular ejection fraction < or =30% versus patients with ejection fraction >30%. Am J Cardiol. 2009;104(12):1717–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Collins Jr JJ, Aranki SF. Management of mild aortic stenosis during coronary artery bypass graft surgery. J Card Surg. 1994;9(2 Suppl):145–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Fighali SF, Avendano A, Elayda MA, et al. Early and late mortality of patients undergoing aortic valve replacement after previous coronary artery bypass graft surgery. Circulation. 1995;92(9 Suppl):II163–8.PubMedGoogle Scholar
  17. 17.
    Florath I, Albert A, Boening A, et al. Aortic valve replacement in octogenarians: identification of high-risk patients. Eur J Cardiothorac Surg. 2010;37(6):1304–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Media / Bohn Stafleu van Loghum 2012

Authors and Affiliations

  • G. A. de Waard
    • 1
  • E. K. Jansen
    • 2
  • M. de Mulder
    • 1
  • A. B. A. Vonk
    • 2
  • V. A. Umans
    • 1
  1. 1.Department of CardiologyMedical Center AlkmaarAlkmaarthe Netherlands
  2. 2.Department of Cardio-Thoracic SurgeryVU Medical CenterAmsterdamthe Netherlands

Personalised recommendations