Li Renxi, Huddleston Stephen J, Prastein Deyanira J
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
J Cardiol. 2025 Feb;85(2):96-97. doi: 10.1016/j.jjcc.2024.08.005. Epub 2024 Aug 16.
Coronary artery disease (CAD) and valvular disease frequently coexist due to similar pathophysiology. Effort has been dedicated to comprehending the outcomes of concomitant coronary revascularization and valve replacement procedures. However, the understanding of how prior valve replacement affects the outcomes of coronary artery bypass grafting (CABG) remains limited. Thus, this study aimed to conduct a population-based examination of the in-hospital outcomes in patients with previous valve replacement in CABG.
Patients who underwent CABG were identified in the National Inpatient Sample in the USA from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between patients with and without previous valve replacement. In-hospital postoperative outcomes were assessed.
There were 514 patients with previous valve replacement who underwent CABG, who were matched to 1588 out of 167,668 controls. After matching, patients with valve replacement had mostly comparable in-hospital outcomes except for a higher risk of vascular complications (1.75 % vs 0.57 %, p = 0.02), a longer length of stay (10.90 ± 7.04 days vs 9.95 ± 6.53 days, p = 0.01), and higher hospital charges (275,465 ± 229,088 US dollars vs 231,648 ± 189,938 US dollars, p < 0.01).
For short-term outcomes, CABG is generally safe for patients who have undergone previous valve replacement, although there is an increased risk of vascular complications that may warrant additional attention. The findings of this study can be valuable for preoperative risk assessment of patients who have had valve replacement and are considering CABG.
由于相似的病理生理学机制，冠状动脉疾病（CAD）和瓣膜疾病常同时存在。人们致力于了解冠状动脉血运重建和瓣膜置换手术同时进行的结果。然而，对于既往瓣膜置换如何影响冠状动脉旁路移植术（CABG）的结果，目前的认识仍然有限。因此，本研究旨在对接受CABG且既往有瓣膜置换史的患者的院内结局进行基于人群的调查。
在美国国家住院患者样本中识别出2015年第4季度至2020年期间接受CABG的患者。排除年龄<18岁及同时进行其他手术的患者。采用1:3倾向评分匹配法，以解决既往有瓣膜置换史和无瓣膜置换史患者在人口统计学、社会经济地位、主要支付者状态、医院特征、合并症以及转院/入院状态方面的差异。评估术后院内结局。
有514例既往有瓣膜置换史的患者接受了CABG，与167,668例对照中的1588例进行了匹配。匹配后，有瓣膜置换史的患者除血管并发症风险较高（1.75%对0.57%，p = 0.02）、住院时间较长（10.90±7.04天对9.95±6.53天，p = 0.01）和医院费用较高（275,465±229,088美元对231,648±189,938美元，p<0.01）外，大多数院内结局具有可比性。
就短期结局而言，CABG对既往有瓣膜置换史的患者总体上是安全的，尽管血管并发症风险增加，可能需要额外关注。本研究结果对于有瓣膜置换史且考虑行CABG的患者的术前风险评估可能具有重要价值。
