title: Previous coronary artery bypass grafting is not a risk factor for aortic valve replacement.
abstract: BACKGROUND
  The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR +/- CABG and the primary combined procedure.
  
  
  METHODS
  Between January 1, 1985, and June 30, 1996, 427 patients underwent primary AVR+CABG, and 52 underwent AVR +/- CABG after prior CABG. Demographics, operative characteristics, and operative results were compared between groups. Data for all patients were pooled and analyzed collectively for risk factors influencing mortality.
  
  
  RESULTS
  The extent of native coronary artery disease and the incidence of prior myocardial infarction and stroke were greater in the reoperative group. Aortic cross-clamp and cardiopulmonary bypass times were slightly shorter, and fewer distal anastomoses were performed in the reoperative group. Operative mortality (primary group, 6.3% versus reoperative group, 7.4%) and morbidity were similar. Stepwise multivariate logistic regression analysis identified age, perioperative myocardial infarction, intraaortic balloon support, ventricular arrhythmia, perioperative stroke, and development of renal failure or acute respiratory distress syndrome, but not reoperative status, as predictors of mortality.
  
  
  CONCLUSIONS
  The risk of AVR after previous CABG is similar to that for primary AVR+CABG. Valve replacement should, therefore, be pursued despite prior CABG when hemodynamically significant aortic stenosis develops. Furthermore, a circumspect approach to "prophylactic" AVR for mild aortic stenosis at primary CABG seems warranted.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110-1013, USA. sundt@wudos2.wustl.edu
authors.forename: T M
authors.initials: TM
authors.lastname: Sundt
authors.forename: S F
authors.initials: SF
authors.lastname: Murphy
authors.forename: B
authors.initials: B
authors.lastname: Barzilai
authors.forename: R B
authors.initials: RB
authors.lastname: Schuessler
authors.forename: E N
authors.initials: EN
authors.lastname: Mendeloff
authors.forename: C B
authors.initials: CB
authors.lastname: Huddleston
authors.forename: M K
authors.initials: MK
authors.lastname: Pasque
authors.forename: W A
authors.initials: WA
authors.lastname: Gay
mesh_terms: D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000150:complications; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications; D005260:Female; D005544:Forecasting; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome