Adding coronary artery bypass grafting to aortic valve replacement increases operative mortality for elderly (70years and older) patients with aortic stenosis

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• 作者：Yasuyuki Sasaki (1)
  Hidekazu Hirai (1)
  Mitsuharu Hosono (1)
  Yasuyuki Bito (1)
  Atsushi Nakahira (1)
  Yasuo Suehiro (1)
  Daisuke Kaku (1)
  Yuko Okada (1)
  Shigefumi Suehiro (1)
  
• 关键词：Aortic stenosis ; Coronary artery bypass grafting ; Aortic valve replacement ; Elderly patients ; Simultaneous AVR and CABG procedures
• 刊名：General Thoracic and Cardiovascular Surgery
• 出版年：2013
• 出版时间：November 2013
• 年：2013
• 卷：61
• 期：11
• 页码：626-631
• 全文大小：
• 作者单位：Yasuyuki Sasaki (1)
  Hidekazu Hirai (1)
  Mitsuharu Hosono (1)
  Yasuyuki Bito (1)
  Atsushi Nakahira (1)
  Yasuo Suehiro (1)
  Daisuke Kaku (1)
  Yuko Okada (1)
  Shigefumi Suehiro (1)
  
  1. Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
  
• ISSN：1863-6713

文摘

Objective This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity. Methods One hundred and fifty-seven elderly patients (70years old or older) undergoing isolated AVR (n=120) or combined AVR/CABG (n=37) were evaluated. Operative outcomes were compared between the two surgical groups. Long-term survival was also compared between the groups using the Kaplaneier method and long-rank (Mantelox) test. Results Operative mortality was 0.8% for the isolated AVR group and 5.4% for the combined AVR/CABG group (p=0.076). The length of the intensive care unit stay for the combined AVR/CABG group was significantly longer than that for the isolated AVR group (median: 40 vs. 21h, p=0.008). However, the occurrence rate of hospital complications, such as reoperation for bleeding, deep sternal infection, supra-ventricular arrhythmia, and neurological complications, was similar between the two groups. Actuarial survival at 3 and 5years was 82.3 and 80.9% for the isolated AVR group, and 88.3 and 73.0% for the combined AVR/CABG group, respectively (p=0.637). Conclusions The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients.