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Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70 years and older) patients with aortic stenosis

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Abstract

Objective

This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity.

Methods

One hundred and fifty-seven elderly patients (70 years old or older) undergoing isolated AVR (n = 120) or combined AVR/CABG (n = 37) were evaluated. Operative outcomes were compared between the two surgical groups. Long-term survival was also compared between the groups using the Kaplan–Meier method and long-rank (Mantel–Cox) test.

Results

Operative mortality was 0.8 % for the isolated AVR group and 5.4 % for the combined AVR/CABG group (p = 0.076). The length of the intensive care unit stay for the combined AVR/CABG group was significantly longer than that for the isolated AVR group (median: 40 vs. 21 h, p = 0.008). However, the occurrence rate of hospital complications, such as reoperation for bleeding, deep sternal infection, supra-ventricular arrhythmia, and neurological complications, was similar between the two groups. Actuarial survival at 3 and 5 years was 82.3 and 80.9 % for the isolated AVR group, and 88.3 and 73.0 % for the combined AVR/CABG group, respectively (p = 0.637).

Conclusions

The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan

    Yasuyuki Sasaki, Hidekazu Hirai, Mitsuharu Hosono, Yasuyuki Bito, Atsushi Nakahira, Yasuo Suehiro, Daisuke Kaku, Yuko Okada & Shigefumi Suehiro

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  1. Yasuyuki Sasaki
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  2. Hidekazu Hirai
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  3. Mitsuharu Hosono
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  4. Yasuyuki Bito
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  5. Atsushi Nakahira
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  6. Yasuo Suehiro
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  7. Daisuke Kaku
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  8. Yuko Okada
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  9. Shigefumi Suehiro
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Correspondence to Yasuyuki Sasaki.

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Sasaki, Y., Hirai, H., Hosono, M. et al. Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70 years and older) patients with aortic stenosis. Gen Thorac Cardiovasc Surg 61, 626–631 (2013). https://doi.org/10.1007/s11748-013-0232-6

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  • DOI: https://doi.org/10.1007/s11748-013-0232-6

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