Prophylactic aortic valve replacement in older patients for mild aortic stenosis during coronary bypass surgery.
Coronary bypass surgery (CBS) is performed in many older patients who frequently also have mild calcific aortic stenosis. It is important that a correct assessment of the severity of aortic stenosis is done by calculating the aortic valve area. Mild aortic stenosis is aortic valve area >1.5 cm(2), >0.9 cm(2)/m(2); severe aortic stenosis is aortic valve area < or =1.0 cm(2), < or =0.6 cm(2)/m(2). Patients who have severe aortic stenosis should have aortic valve replacement (AVR) at the time of CBS. Patients with mild aortic stenosis should not have AVR simultaneously with CBS because: 1) patients having AVR+CBS have a higher operative and 10-year mortality; 2) prosthetic heart valves are associated with a complication rate of 2%-6% per year; and 3) only about 12% of patients with mild aortic stenosis will have developed severe aortic stenosis in 10 years. Performing AVR for mild aortic stenosis at the time of CBS will probably result in 91 unnecessary AVRs and 29 excess deaths in 10 years.
Griffith Center, Division of Cardiology, Department of Medicine LAC+USC Medical Center and Keck School of Medicine,University of Southern California, Los Angeles, CA 90033, USA.
Mahmoud
M
Eslami
Shahbudin H
SH
Rahimtoola
D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery; D015150:Echocardiography, Doppler; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome