Management of patients with mild aortic stenosis undergoing coronary artery bypass grafting.
BACKGROUND
The management of mild aortic stenosis during coronary artery bypass grafting remains controversial.


METHODS
We reviewed the medical records of consecutive patients between January 1, 1977, and December 31, 1994, to identify 51 patients with mild aortic stenosis who underwent isolated coronary artery bypass grafting (group A), and 19 patients with mild aortic stenosis who underwent combined coronary artery bypass grafting and aortic valve replacement (group B). Patients with more than moderate aortic regurgitation were excluded. Preoperative angiograms were reviewed to assess the severity of calcification and restricted mobility of the aortic cusps.


RESULTS
In group A there were 11 deaths and 8 subsequent aortic valve replacements; in group B there were 5 deaths and 3 prosthetic valve-related complications. There was no difference in event-free survival between the two groups after adjusting for the difference in age. Among group A patients, the initial transvalvular gradient (p = 0.0005) and aortic valvular calcification (p = 0.06) identified patients who demonstrated progression to severe aortic stenosis during follow-up.


CONCLUSIONS
Our data suggest that routine aortic valve replacement during coronary artery bypass grafting in patients with mild aortic stenosis is not indicated, but concomitant aortic valve replacement may be appropriate in patients with higher transvalvular gradients and calcified valves.
Tam
J W
JW
University of Ottawa Heart Institute, Ontario, Canada.
Masters
R G
RG
Burwash
I G
IG
Mayhew
A D
AD
Chan
K L
KL
D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001027:Aortography; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000009:adverse effects; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate