Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery

Jeremy J. Pereira, Krzysztof Balaban, Michael S. Lauer, Bruce Lytle, James D. Thomas, Mario J. Garcia

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery. METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient <0 mm Hg and/or valve area >1.5 cm2) or moderate (mean gradient ≥30 and ≤40 mm Hg and/or valve area >1.0 ≤1.5cm2) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P <0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04). CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis.

Original languageEnglish (US)
Pages (from-to)735-742
Number of pages8
JournalAmerican Journal of Medicine
Volume118
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

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Aortic Valve Stenosis
Aortic Valve
Coronary Artery Bypass
Survival
Kaplan-Meier Estimate
Survival Analysis
Confidence Intervals
Mortality

Keywords

  • Aortic stenosis
  • Coronary artery bypass
  • Echocardiography
  • Valve prostheses

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery. / Pereira, Jeremy J.; Balaban, Krzysztof; Lauer, Michael S.; Lytle, Bruce; Thomas, James D.; Garcia, Mario J.

In: American Journal of Medicine, Vol. 118, No. 7, 07.2005, p. 735-742.

Research output: Contribution to journalArticle

Pereira, Jeremy J. ; Balaban, Krzysztof ; Lauer, Michael S. ; Lytle, Bruce ; Thomas, James D. ; Garcia, Mario J. / Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery. In: American Journal of Medicine. 2005 ; Vol. 118, No. 7. pp. 735-742.
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N2 - PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery. METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient <0 mm Hg and/or valve area >1.5 cm2) or moderate (mean gradient ≥30 and ≤40 mm Hg and/or valve area >1.0 ≤1.5cm2) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P <0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04). CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis.

AB - PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery. METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient <0 mm Hg and/or valve area >1.5 cm2) or moderate (mean gradient ≥30 and ≤40 mm Hg and/or valve area >1.0 ≤1.5cm2) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P <0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04). CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis.

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