title: Incidence and implications of coronary artery disease in patients undergoing valvular heart surgery: the Indian scenario.
abstract: OBJECTIVE
  We evaluated the incidence and implications of coronary artery disease (CAD) in patients above 40 years presenting for valve surgery.
  
  
  METHODS
  Between January 2009 and December 2010, coronary angiography (CAG) was performed in all such patients ( n = 140).
  
  
  RESULTS
  Coronaries were normal in 119 (Group I), and diseased in 21 (Group II). In Group II, 11 patients were < 50 years, 3 were between 51 and 60 years and 7 were > 61 years. In 8 of these, only valve replacement was performed. Coronary artery bypass grafting (CABG) and aortic valve replacement was performed in 10, CABG and mitral valve replacement in 2 and CABG with mitral and aortic valve replacement in one. The number of vessels grafted in these 13 patients was 1.54 ± 0.66. Hypertension and diabetes were significant ( P < 0.05) in this group. The mortality was significant in Group II (11 vs. 6, P < 0.05). Six patients died in Group II, 5 had severe aortic stenosis and severe left ventricular hypertrophy; the sixth patient had severe mitral stenosis and was in CHF. The predominant cause of death was congestive heart failure (CHF).
  
  
  CONCLUSIONS
  Fifteen percentage of these patients had CAD. CAG should be performed routinely in these patients while presenting for valve surgery. Combined CABG and valve replacement carries high mortality (28.5%), especially in patients with aortic stenosis. The study suggests that the cardio-protective measures should be applied more rigorously in this subset of patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care, G. B. Pant Hospital, New Delhi, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Tempe
authors.forename: Sanjula
authors.initials: S
authors.lastname: Virmani
authors.forename: Rupak
authors.initials: R
authors.lastname: Gupta
authors.forename: Vishnu
authors.initials: V
authors.lastname: Datt
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Joshi
authors.forename: Aastha
authors.initials: A
authors.lastname: Dhingra
authors.forename: Rahul
authors.initials: R
authors.lastname: Dutta
authors.forename: Harpreet Singh
authors.initials: HS
authors.lastname: Minhas
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged