Document Detail


Aortic valve replacement and concomitant coronary artery bypass: assessing the impact of multiple grafts.
MedLine Citation:
PMID:  17307443     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The impact of multivessel coronary artery disease and multivessel coronary artery bypass grafting on outcomes after combined aortic valve replacement and coronary artery bypass grafting (AVR-CABG) has not been sufficiently evaluated. METHODS: We retrospectively reviewed all patients who underwent AVR-CABG at our institution between January 2000 and December 2004. Patients with any previous or concomitant procedures were excluded. The Kaplan-Meier method was used to calculate survival and freedom from postoperative repeat revascularization. Predictors of mortality were determined by Cox regression analysis. RESULTS: The study cohort consisted of 233 AVR-CABG patients. Mean follow-up was 2.2 +/- 1.7 years with one patient lost to follow-up. Preoperative clinical characteristics were well-matched between patients who received one (n = 86), two (n = 81), or three or four (n = 66) bypass grafts. Operative mortality was 9.3%, 11.1%, and 7.6%, respectively (p = 0.76). Patients in all groups demonstrated significant improvement in New York Heart Association (NYHA) status (p < 0.01). Freedom from postoperative repeat revascularization for all patients after five years was 96.8% and did not differ among groups (p = 0.93). Five-year survival for each group was 63.6%, 72.4%, and 63.9%, respectively (p = 0.91). Emergent operation, ejection fraction less than 0.30, operative age greater than 65 years, NYHA class III/IV, and chronic obstructive pulmonary disease were significant predictors of mortality. The number of stenosed vessels, the number of bypass grafts, incomplete revascularization, and the presence of aortic stenosis or aortic insufficiency did not predict mortality. CONCLUSIONS: For patients undergoing AVR-CABG, the number of bypass grafts does not adversely affect survival. Rather, a patient's preoperative risk factors are a better predictor of outcome.
Authors:
Kimiyoshi J Kobayashi; Jason A Williams; Lois Nwakanma; Vincent L Gott; William A Baumgartner; John V Conte
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-19     Completed Date:  2007-03-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  969-78     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4618, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Aortic Valve / surgery*
Cohort Studies
Coronary Artery Bypass* / methods,  mortality
Coronary Artery Disease / complications*,  physiopathology,  surgery
Emergency Treatment
Female
Follow-Up Studies
Heart Valve Diseases / complications*,  surgery
Heart Valve Prosthesis Implantation* / mortality
Humans
Male
Prognosis
Pulmonary Disease, Chronic Obstructive / complications
Retrospective Studies
Severity of Illness Index
Stroke Volume
Survival Analysis
Treatment Outcome
Comments/Corrections
Comment In:
Ann Thorac Surg. 2007 Mar;83(3):978   [PMID:  17307444 ]

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