Results of concomitant aortic valve replacement and coronary artery bypass grafting in the VA population.
OBJECTIVE
Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is an established risk factor for diminished postoperative survival. Results from a VA population were reviewed in order to determine factors influencing early and late survival.


METHODS
Between 1993 and 2003, a total of 401 patients underwent AVR at the authors' institution. Of these patients, 249 (62%; mean age 70.6 years) had combined AVR and CABG. Surgical indications were primarily aortic valve pathology (group A: n = 168; 68%), primarily coronary artery disease (CAD) (group B: n = 55; 22%), and both severe aortic and coronary disease (group C: n = 26; 10%). In total, 177 patients (71%) received a bioprosthesis, and 72 (29%) received a mechanical valve. Short- and long-term outcomes were explored using univariate and multivariable hazard analyses.


RESULTS
Overall operative mortality was 6.4%; mortality for groups A, B and C was 4.8%, 9.1% and 11.5%, respectively. On multivariable analysis, significant factors associated with early-phase mortality were NYHA class IV, diabetes, bioprosthetic valve and combined severe aortic and coronary disease. Survival at one and five years was 86% and 62%, respectively. Five-year survival for groups A, B and C was 71%, 63% and 54%, respectively. Significant associated factors for late-phase mortality were the presence of preoperative peripheral vascular disease (PVD) and cerebrovascular disease (CVD). Factors such as age, prior cardiac surgery, number of grafted coronary arteries, and/or effective orifice area index (EOAI) had no significant effect on outcome.


CONCLUSIONS
Combined AVR/CABG is a marker for decreased survival. Pre-existing factors such as diabetes, PVD and CVD, as well as poor preoperative NYHA functional status, affected survival. Further investigation is needed to assess the influence of the severity of CAD and EOAI on survival. Thoughtful consideration of all these factors is essential for an accurate prediction of survival, and to determine the appropriate type of aortic prosthesis to be used.
Division of Cardiothoracic Surgery of Portland VA Hospital, Oregon, USA. balsoufi@hotmail.com
Bahaaldin
B
Alsoufi
Tara
T
Karamlou
Matthew
M
Slater
Irving
I
Shen
Ross
R
Ungerleider
Pasala
P
Ravichandran
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D009922:Oregon; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans