title: Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70 years and older) patients with aortic stenosis.
abstract: OBJECTIVE
  This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity.
  
  
  METHODS
  One hundred and fifty-seven elderly patients (70 years old or older) undergoing isolated AVR (n = 120) or combined AVR/CABG (n = 37) were evaluated. Operative outcomes were compared between the two surgical groups. Long-term survival was also compared between the groups using the Kaplan-Meier method and long-rank (Mantel-Cox) test.
  
  
  RESULTS
  Operative mortality was 0.8 % for the isolated AVR group and 5.4 % for the combined AVR/CABG group (p = 0.076). The length of the intensive care unit stay for the combined AVR/CABG group was significantly longer than that for the isolated AVR group (median: 40 vs. 21 h, p = 0.008). However, the occurrence rate of hospital complications, such as reoperation for bleeding, deep sternal infection, supra-ventricular arrhythmia, and neurological complications, was similar between the two groups. Actuarial survival at 3 and 5 years was 82.3 and 80.9 % for the isolated AVR group, and 88.3 and 73.0 % for the combined AVR/CABG group, respectively (p = 0.637).
  
  
  CONCLUSIONS
  The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan, ysasaki@msic.med.osaka-cu.ac.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirai
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Hosono
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Bito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakahira
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suehiro
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaku
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okada
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis