Perioperative risk of aortic valve replacement after coronary artery bypass grafting.

OBJECTIVE

To evaluate the operative risk of aortic valve replacement (AVR) after coronary artery bypass grafting (CABG).

METHODS

Twenty patients (sixteen male, four female) underwent AVR 1.5-20 years (mean: 8.2) after CABG.

RESULTS

Patients had received a mean number of four bypass grafts (2-5) with the use of the left internal thoracic artery in seventeen patients. Mean age at the time of AVR was 70.5 years (57-82). All patients suffered from an aortic stenosis with a mean orifice area of 0.74 cm (2) (0.34-1.1) and a mean pressure gradient of 52.4 mm Hg (22-78). Ten mechanical (mean diameter 23.6 mm, 21-27) and ten biological (22.1 mm, 19-25) prostheses were implanted. Mean duration of surgery, cardiopulmonary bypass (CPB) and cross-clamp time were 322.1 (205-645), 169.2 (87-411), and 77.1 (46-128) minutes, respectively. Fourteen patients had an uneventful postoperative course. A temporary neurological impairment, renal failure, and re-intubation for respiratory insufficiency for nine hours occurred in one patient each. Two patients died postoperatively (day 3 and 10) due to multiple cerebral infarctions. One patient required a replacement of the ascending aorta in deep hypothermia and re-implantation of the bypasses. He suffered from gastrointestinal bleeding on postoperative day 14 and expired on day 81 because of multi-organ failure.

CONCLUSION

Aortic valve replacement after coronary artery bypass grafting is associated with an enhanced perioperative risk requiring meticulous decision-making and a sophisticated operative technique.