title: Perioperative risk of aortic valve replacement after coronary artery bypass grafting.
abstract: OBJECTIVE
  To evaluate the operative risk of aortic valve replacement (AVR) after coronary artery bypass grafting (CABG).
  
  
  METHODS
  Twenty patients (sixteen male, four female) underwent AVR 1.5-20 years (mean: 8.2) after CABG.
  
  
  RESULTS
  Patients had received a mean number of four bypass grafts (2-5) with the use of the left internal thoracic artery in seventeen patients. Mean age at the time of AVR was 70.5 years (57-82). All patients suffered from an aortic stenosis with a mean orifice area of 0.74 cm (2) (0.34-1.1) and a mean pressure gradient of 52.4 mm Hg (22-78). Ten mechanical (mean diameter 23.6 mm, 21-27) and ten biological (22.1 mm, 19-25) prostheses were implanted. Mean duration of surgery, cardiopulmonary bypass (CPB) and cross-clamp time were 322.1 (205-645), 169.2 (87-411), and 77.1 (46-128) minutes, respectively. Fourteen patients had an uneventful postoperative course. A temporary neurological impairment, renal failure, and re-intubation for respiratory insufficiency for nine hours occurred in one patient each. Two patients died postoperatively (day 3 and 10) due to multiple cerebral infarctions. One patient required a replacement of the ascending aorta in deep hypothermia and re-implantation of the bypasses. He suffered from gastrointestinal bleeding on postoperative day 14 and expired on day 81 because of multi-organ failure.
  
  
  CONCLUSIONS
  Aortic valve replacement after coronary artery bypass grafting is associated with an enhanced perioperative risk requiring meticulous decision-making and a sophisticated operative technique.
authors.affiliation: Department of Cardiothoracic Surgery, University of Aachen, Aachen, Germany. schristiansen@ukaachen.de
authors.forename: S
authors.initials: S
authors.lastname: Christiansen
authors.forename: R
authors.initials: R
authors.lastname: Autschbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome