The impact of coronary artery disease severity on late survival after combined aortic valve replacement and coronary artery bypass grafting - experience of a single cardiac surgery center.
BACKGROUND
The severity of coronary artery disease (CAD) may have an impact on the outcomes of patients (pts) after aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).


OBJECTIVE
The aim of the study was to analyze survival after simultaneous AVR and CABG with respect to CAD severity.


METHODS
The study involved 143 consecutive pts (40 women and 103 men) with a mean age of 65.1 ± 7.7 years treated between 2006 and 2009. The indication for surgery was aortic stenosis accompanied by left main or three-vessel disease (group A; n = 43) and by single- or two-vessel disease (group B; n = 100). In-hospital and late mortality were analyzed. Post-discharge survival was estimated using the Kaplan-Meier method. Moreover, selected preoperative clinical and echocardiographic data as well as intraoperative variables were compared between the groups.


RESULTS
In-hospital mortality was 4.7% in group A and 3.0% in group B (NS). The 12-month and 48-month survival probability rates were 0.88 ± 0.05 and 0.83 ± 0.06 in group A, and 0.97 ± 0.01 and 0.92 ± 0.03 in group B, respectively (p < 0.05). Patients in group A and B differed (p < 0.05) with respect to the preoperative prevalence of arterial hypertension (65.1% vs. 42.0%) and atrial fibrillation (18.6% vs. 6.0%) as well as with regard to the rate of complete revascularization (20.9% vs. 85.0%, group A and B, respectively).


CONCLUSIONS
Coronary artery disease severity impacts long-term survival after combined AVR and CABG. Patients with left main or three-vessel disease more often undergo incomplete surgical revascularization, and this fact may be one of the predictors of an unfavorable outcome.
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Bartłomiej
B
Perek
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Marcin
M
Misterski
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Wojciech
W
Stachowiak
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Piotr
P
Buczkowski
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Sebastian
S
Stefaniak
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Mateusz
M
Puślecki
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Tomasz
T
Urbanowicz
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Wiktor
W
Budniak
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Marek
M
Jemielity
aortic valve replacement; combined procedures; coronary artery disease; long-term outcomes; mortality