Document Detail

Moderate aortic stenosis in coronary artery bypass grafting patients more than 70 years of age: to replace or not to replace?
MedLine Citation:
PMID:  20971247     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Moderate aortic stenosis in coronary artery bypass graft surgery (CABG) patients more than 70 years old is not unusual. The risk-benefit of performing a concomitant aortic valve replacement (AVR) is often difficult to assess. To stratify the risk-benefit ratio, we reviewed outcomes of CABG patients more than 70 years old with preoperative moderate aortic stenosis (valve area 1.0 to 1.6 cm(2) or indexed valve area 0.6 to 1.0 cm(2)/m(2)). METHODS: Among 263 CABG patients more than 70 years old with moderate aortic stenosis, 167 patients underwent only CABG and 96 had CABG+AVR. RESULTS: Cross-clamp time (p < 0.0001) and perioperative transient ischemic attack-cerebrovascular accident (p < 0.04) were significantly higher in the CABG+AVR group. In-hospital mortality was comparable among groups (CABG 6.0% versus CABG+AVR 4.2%; p = 0.8). At a mean follow-up of 4.5 ± 3.0 years, 5-year survival (CABG 64.2% ± 4.3% versus CABG+AVR 62.3% ± 5.5%) and freedom from AVR (CABG 97.8% ± 1.2% versus CABG+AVR 98.9% ± 1.1%; p = 0.13) were comparable among both groups. Among patients treated with CABG alone, receiver operating characteristic curve analysis identified 26 mm Hg and 15 mm Hg as maximum and mean aortic valve gradients, respectively, for increased risk of reoperation for late AVR. Multivariate analyses for predictors of operative mortality were preoperative renal failure (odds ratio [OR] 7.64, p < 0.001) and intubation more than 48 hours (OR 11.10, p < 0.0002); for late death, ejection fraction less than 40% (OR 3.35, p < 0.02), New York Heart Association functional class III or IV (OR 2.37, p < 0.002), chronic obstructive pulmonary disease (OR 2.26, p < 0.02), and renal failure (OR 3.03, p < 0.003); for perioperative transient ischemic attack-cerebrovascular accident, cross-clamp time (OR 1.02, p < 0.02) and Parsonnet score (OR 1.09, p < 0.05). CONCLUSIONS: For CABG patients more than 70 years old with minimal comorbidities especially in the presence of aortic gradients of 26/15 mm Hg or greater, concomitant AVR for moderate aortic stenosis should be performed during CABG and may be performed with minimal additional operative risk. Patients with significant comorbidities should be managed with CABG alone, owing to an increased perioperative risk, poor midterm survival, and minimal risk of AVR at 5 years.
François Dagenais; Patrick Mathieu; Daniel Doyle; Éric Dumont; Pierre Voisine
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1495-9; discussion 1499-500     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Ontario, Canada.
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MeSH Terms
Aortic Valve / surgery
Aortic Valve Stenosis / surgery*
Coronary Artery Bypass / adverse effects*,  mortality
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Ischemic Attack, Transient / etiology
Kidney Failure / mortality
Pulmonary Disease, Chronic Obstructive / mortality
Risk Factors

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