title: Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery.
abstract: OBJECTIVE
  The aim of this study was to summarize the immediate outcome after aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG).
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  Participants were 683,286 patients who underwent AVR with or without CABG. Patients undergoing other major cardiac procedures were excluded from this analysis.
  
  
  METHODS
  AVR with or without CABG.
  
  
  RESULTS
  Operative mortality after AVR with or without concomitant CABG was 4.3%, stroke 2.1%, pacemaker implantation 5.9%, and dialysis 2.2%. After isolated AVR, operative mortality was 3.3%, stroke 1.7%, pacemaker implantation 3.3%, and dialysis 1.6%. Mortality was increased among very elderly (< 60 years: 3.3%, 60-69 years: 2.7%, 70-79 years: 3.8%,≥ 80 years: 6.1%, p < 0.001). Prevalence of minimally invasive AVR (mini-AVR) was associated with significantly lower operative mortality (p = 0.039, 46 studies). Mini-AVR only tended toward lower mortality when included in meta-regression analysis as a dichotomous variable (mini-AVR 4,367 patients: 2.3%, 95% CI 1.8-2.9% v full sternotomy 11,076 patients: 3.5%, 95% CI 28-4.1%, p = 0.088). Operative mortality after AVR plus CABG was 5.5% (versus isolated AVR: p < 0.001), stroke 3.0%, pacemaker implantation 3.9%, and dialysis 5.6%. Mortality was high in all age strata, particularly among very elderly (mean age < 70 years: 4.8%, mean age 70-79 years: 4.7%; mean age ≥ 80 years: 8.4%, p = 0.002).
  
  
  CONCLUSIONS
  Isolated AVR is associated with low mortality and morbidity. Coronary artery disease requiring concomitant CABG increases the operative mortality. Patients requiring AVR and CABG should be the main target of less-invasive treatment strategies.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Marta
authors.initials: M
authors.lastname: Martin
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bordin
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Elia
authors.initials: E
authors.lastname: Vettore
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vinco
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Vesa
authors.initials: V
authors.lastname: Anttila
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vasques
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000639:trends; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D013223:Statistics as Topic; D016896:Treatment Outcome
keywords: AVR + CABF; Mini-AVR; TAVI; aortic stenosis; aortic valve; cardiac surgery; coronary artery bypass; outcome; risk; transcatheter aortic valve implantation