Aortic valve replacement for aortic stenosis after previous coronary artery bypass grafting: could early reoperation be prevented?
OBJECTIVE
The study aim was to examine, retrospectively, the risk of accelerated progression of aortic stenosis (AS) and outcome after aortic valve replacement (AVR) in patients who had undergone previous coronary artery bypass graft (CABG) surgery.


METHODS
Between 1994 and 2004, 81 patients with mild-to-moderate AS at the time of CABG underwent subsequent AVR. The mean EuroScore was 10.8 +/- 1.8. The population was divided into three subgroups according to the time interval between AVR and CABG: group A, < 5 years (n = 23); group B, 5-10 years (n = 34); and group C, > 10 years (n = 24).


RESULTS
Mean age at the time of CABG was 70 +/- 5, 64 +/- 6 and 58 +/- 5 years in groups A, B, and C, respectively. The peak transvalvular gradient was < or = 30 mmHg in 65 patients (80.2%), and 30-50 mmHg in 16 (19.7%). Operative mortality after AVR was 16% in the overall population (30%, 11.7%, and 8.6% in groups A, B, and C, respectively). The mean time interval between CABG and AVR was 8.9 +/- 5.2 years. By multivariate analysis, a peak transvalvular gradient > or = 30 mmHg (p = 0.003), moderate calcifications with moderately-to-severely limited valve motion (p = 0.05), and left ventricular hypertrophy (LVH) (p = 0.005) were independent predictors of AVR within five years of CABG surgery. Systemic vascular atherosclerotic disease was a predictor of rapid disease progression by univariate analysis, and a predictor of operative mortality by multivariate analysis.


CONCLUSIONS
Because of the high mortality associated with repeat operations within five years, AVR should be considered at the time of CABG in patients aged < or = 75 years, with a peak transvalvular gradient > 30 mmHg, moderately prominent calcifications with moderately to severely limited valve motion, and LVH.
Verhoye
Jean Ph
JP
Department of Thoracic and Cardiovascular Surgery, University Hospital, Ponchaillou, Rennes, France. jean-philippe.verhoye@chu-rennes.fr
Merlicco
Franceseca
F
Sami
Ibrahim M
IM
Cappabianca
Giangiuseppe
G
Lecouls
Hervé
H
Corbineau
Hervé
H
Langanay
Thierry
T
Leguerrier
Alain
A
D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome