title: Long-term outcome of isolated off-pump coronary artery bypass grafting in patients with coronary artery disease and mild to moderate aortic stenosis.
abstract: The best management strategy for patients with coronary disease and mild to moderate AS requires the clinician to consider the operative risks of isolated coronary artery bypass grafting (CABG) against the risks of untreated aortic stenosis (AS).
  
  
  
  Between 2000 and 2014, isolated off-pump CABG (OPCAB) was performed in 2023 patients. Of these patients, 103 presented with mild or moderate AS (mean age 72.7±6.3 years; 23 females), 96 (93.2%) presented with mild AS and seven (6.8%) presented with moderate AS. We compared the long-term outcome of these 103 patients undergoing isolated OPCAB with 13 patients who presented with moderate AS and coronary artery disease (CAD) and underwent concomitant aortic valve replacement (AVR) and CABG during the same period.
  
  
  
  Mean number of distal anastomoses was 3.7±0.9 per patient, and early graft patency was 98.9% (365 of 369 grafts). No patient required on-pump CABG or concomitant AVR. There were two in-hospital deaths (1.9%). Cumulative 5- and 10-year survival rates were 78.3% and 56.6%, respectively. The respective 5- and 10-year rates of freedom from severe AS were 38.1% and 0.0% in patients with moderate AS, and 73.2% and 65.4% in patients with mild AS (log-rank test, p<0.01). Twelve patients required subsequent AVR, including eight who underwent transcatheter AVR. There were no significant differences between patients undergoing isolated OPCAB and patients undergoing concomitant AVR and CABG according to cumulative survival rate (log rank test, p=0.78) and freedom from major adverse cardiac and cerebrovascular events (log rank test, p=0.59).
  
  
  
  Isolated OPCAB is a reasonable staged strategy in coronary disease with mild AS, as the less invasive option of transcatheter AVR is available later if required.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kizuku
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: tomofujita@nifty.com.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Kume
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: AS; AVR; OPCAB; TAVI; TAVR