Conventional aortic valve replacement in patients with concomitant coronary artery disease and previous coronary artery bypass grafting in the era of interventional approaches.
OBJECTIVE
In patients with symptomatic aortic valve stenosis and a high estimated operative risk due to previous coronary artery bypass grafting (CABG) procedures, interventional aortic valve implantation techniques may ultimately prove superior. However, recent studies have revealed increased mortality and impaired survival in patients with concomitant coronary artery disease (CAD).


METHODS
Between January 1996 and May 2010, 60 patients (73 ± 6 years, 15 female (25%)) underwent conventional operation 9 ± 6 years after CABG for symptomatic aortic valve stenosis (European System for Cardiac Operative Risk Evaluation, EuroSCORE) standard 11 ± 3%, logistic 27 ± 17%, Society of Thoracic Surgeons (STS) Score 19 ± 8%). Coronary angiography revealed open grafts and no need for further revascularization in all patients. High-risk patients were identified (log. EuroSCORE≥ 20%, n = 34) and divided by age (< 75 years, n=15; ≥ 75 years, n=19) for sub-group analysis. Follow-up for all 60 patients was performed according to the current guidelines: quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ).


RESULTS
Thirty-day-mortality was 5% (n=3). During follow-up (100% complete), 18 patients died. Thus, 1-, 3- and 5-year survival was 91%, 77%, and 69%, respectively. No differences in survival could be detected between the two high-risk groups. Quality of life revealed excellent results for the entire cohort, as well as both high-risk groups.


CONCLUSIONS
Conventional surgery in patients with symptomatic aortic valve stenosis after previous CABG can be performed with excellent results despite a high calculated risk, independent of age. Although conventional surgery is technically more demanding and associated with substantial surgical trauma, it is justified by the excellent survival and high quality of life in this high-risk patient cohort.
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Katharina
K
Redlich
Nawid
N
Khaladj
Sven
S
Peterss
Maximilian
M
Pichlmaier
Malakh
M
Shrestha
Ludwig
L
Hoy
Axel
A
Haverich
Christian
C
Hagl
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011788:Quality of Life; D012086:Reoperation; D016896:Treatment Outcome