Conventional aortic valve replacement in patients with concomitant coronary artery disease and previous coronary artery bypass grafting in the era of interventional approaches

Redlich, Katharina; Khaladj, Nawid; Peterss, Sven; Pichlmaier, Maximilian; Shrestha, Malakh; Hoy, Ludwig; Haverich, Axel; Hagl, Christian
August 2011
European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p455
Academic Journal
Abstract: Objective: In patients with symptomatic aortic valve stenosis and a high estimated operative risk due to previous coronary artery bypass grafting (CABG) procedures, interventional aortic valve implantation techniques may ultimately prove superior. However, recent studies have revealed increased mortality and impaired survival in patients with concomitant coronary artery disease (CAD). Methods: Between January 1996 and May 2010, 60 patients (73±6 years, 15 female (25%)) underwent conventional operation 9±6 years after CABG for symptomatic aortic valve stenosis (European System for Cardiac Operative Risk Evaluation, EuroSCORE) standard 11±3%, logistic 27±17%, Society of Thoracic Surgeons (STS) Score 19±8%). Coronary angiography revealed open grafts and no need for further revascularization in all patients. High-risk patients were identified (log. EuroSCORE≥20%, n =34) and divided by age (<75 years, n =15; ≥75 years, n =19) for sub-group analysis. Follow-up for all 60 patients was performed according to the current guidelines: quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: Thirty-day-mortality was 5% (n =3). During follow-up (100% complete), 18 patients died. Thus, 1-, 3- and 5-year survival was 91%, 77%, and 69%, respectively. No differences in survival could be detected between the two high-risk groups. Quality of life revealed excellent results for the entire cohort, as well as both high-risk groups. Conclusions: Conventional surgery in patients with symptomatic aortic valve stenosis after previous CABG can be performed with excellent results despite a high calculated risk, independent of age. Although conventional surgery is technically more demanding and associated with substantial surgical trauma, it is justified by the excellent survival and high quality of life in this high-risk patient cohort.


Related Articles

  • Pseudoaneurysm of the mitral-aortic intervalvular fibrosa and complementary role of 3D transesophageal echocardiographic imaging. Velibey, Yalçın; Güngör, Barış; Bolca, Osman; Eren, Mehmet // Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi;Dec2013, Vol. 13 Issue 8, pE44 

    No abstract available.

  • Watchful observation versus early aortic valve replacement for symptomatic patients with normal flow, low-gradient severe aortic stenosis. Rizzo, Stefania; Basso, Cristina; Bottio, Tomaso // Heart;Sep2015, Vol. 101 Issue 17, p1375 

    Objectives: The timing of aortic valve replacement (AVR) remains controversial in symptomatic patients with normal flow, low-gradient severe aortic stenosis (AS) and preserved LVEF. We sought to compare long-term mortality of early AVR versus a watchful observation strategy. Methods: From 2000...

  • Factors associated with poor self-reported health status after aortic valve replacement with or without concomitant bypass surgery. Oterhals, Kjersti; Hanssen, Tove Aminda; Haaverstad, Rune; Nordrehaug, Jan Erik; Eide, Geir Egil; Norekvål, Tone M. // European Journal of Cardio-Thoracic Surgery;Aug2015, Vol. 48 Issue 2, p283 

    OBJECTIVES: Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant...

  • Effect of Off-Pump Coronary Artery Bypass Surgery on Patients' Quality of Life. Afrand, Mohammadhosain; Froozan-Nia, Seyed Khalil; Dehghani, Hamide; Jalalian, Mehrdad; Sarebanhassanabadi, Mohammadtaghi // Cardiology Research;2014, Vol. 5 Issue 1, p30 

    Background: Off-pump coronary artery bypass (OPCAB) surgery is a common technique used to control the incidence of myocardial ischemia and to increase the lifespan of patients with coronary artery disease (CAD). There is still considerable controversy about effect of OPCAB on patients' quality...

  • Quality of Life After PCI vs CABG Among Patients With Diabetes and Multivessel Coronary Artery Disease A Randomized Clinical Trial. Abdallah, Mouin S.; Kaijun Wang; Magnuson, Elizabeth A.; Spertus, John A.; Farkouh, Michael E.; Fuster, Valentin; Cohen, David J. // JAMA: Journal of the American Medical Association;10/16/2013, Vol. 310 Issue 15, p1581 

    IMPORTANCE The FREEDOM trial demonstrated that among patients with diabetes mellitus and multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery resulted in lower rates of death and myocardial infarction but a higher risk of stroke when compared with percutaneous...

  • Transcatheter Aortic Valve Replacement: Important Considerations. Hitt, Emma // MD Conference Express;Aug2013, Vol. 13 Issue 7, p24 

    Although surgical aortic valve replacement is recommended by clinical practice guidelines in patients with severe aortic stenosis, many patients with calcific aortic stenosis are not optimal candidates for surgery due to their medical comorbidities. Transcatheter aortic valve replacement (TAVR)...

  • Cardiovascular Complications.  // Current Medical Literature: Diabetes;2012, Vol. 29 Issue 4, p124 

    The article discusses studies on cardiovascular complications of diabetes, published in medical journals in 2012. J. S. Rana and colleagues examined individuals who underwent coronary computed tomography angiography and compared individuals with diabetes with those without the condition. F....

  • Refractory Vascular Spasm Associated with Coronary Bypass Grafting. Young Sam Kim; Yong Han Yoon; Jeoung Taek Kim; Ki Shinn, Helen; Seong Ill Woo; Wan Ki Baek // Korean Journal of Thoracic & Cardiovascular Surgery;Oct2014, Vol. 47 Issue 5, p468 

    Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a re-current left main coronary artery disease. A hemodynamic...

  • Transcatheter aortic valve implantation after previous coronary artery bypass grafting: a potential gold standard of care. Drews, Thorsten // European Journal of Cardio-Thoracic Surgery;Mar2012, Vol. 41 Issue 3, p504 

    The author reflects on patients undergoing transcatheter aortic valve implantation (TAVI) after previous coronary artery bypass grafting. He states that TAVI must be combined with percutaneous coronary intervention to treat the most significant coronary lesions. He concludes that TAVI procedure...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics