Concomitant CABG-procedures in elderly patients undergoing aortic valve replacement. An additional risk factor?

OBJECTIVE

Preoperative coronary angiography in elderly people referred to the hospital for aortic valve replacement (AVR) often shows additional significant stenoses of the coronary arteries (CAD). The benefit of concomitant coronary artery bypass grafting (CABG) in these patients is still discussed controversially. By some authors, an isolated AVR in elderly patients with additional CAD is even described to have a better outcome.

PATIENTS AND METHODS

We analyzed 283 patients (> or =75 years), undergoing AVR with or without concomitant CABG-procedures. We particularly analyzed those patients who were operated with an isolated AVR in spite of preoperatively known CAD. There were 166 patients in the AVR group (gr. A) and 117 patients in the AVR+CABG group (gr. AC). 51 of these patients with isolated AVR were preoperatively known to have an additional CAD (stenoses <60%) (gr. A2), whereas 115 patients of group A only suffered from an isolated aortic valve disease (gr. A1).

RESULTS

Comparing group A and AC, we found a significantly prolonged mechanical ventilation in group AC (22.3+/-5.3 hours vs 10.1+/-1.9 h in gr. A, p<0.05) and a longer stay on the ICU. The incidence of severe postoperative complications and the in-hospital mortality were comparable. In group A2 we could differ between stenoses of the LAD (n=19) and of the right coronary or circumflex artery (n=32). The decision not to bypass a stenosis of the LAD caused a significantly worse outcome of these patients compared to group AC. Ignoring stenoses of the RCA or RCx was not correlated with an impaired postoperative result.

CONCLUSIONS

With our results we could not identify concomitant CABG as a predictor of poor surgical outcome in elderly patients with AVR. We could even show that an additional bypass grafting of moderate stenoses of the LAD is important for a good outcome of these patients. Comparable stenoses in the right coronary or circumflex artery may be ignored with the advantage of a shorter period of intraoperative ischemia and the possibility of a secondary catheter intervention.