Eastern Cardiothoracic Surgical Society

Concomitant Bypass Grafts Have no Impact on Early or Long-Term Outcomes Following Isolated Aortic Valve Replacement
Mark A. Groh1, Ivan Diaz2, Stephen W. Ely1, Oliver A. Binns1, Alan M. Johnson1, Gerard L. Champsaur3, 1Mission Heart, Asheville, NC, 2Johns Hopkins University, Baltimore, MD, 3Mission Hospital, Asheville, NC

OBJECTIVE: Contemporary standard therapy of aortic stenosis with or without ischemic heart disease remains surgical, and there is no current global consensus on the benefits of concomitant coronary artery bypass graft (CABG). In the era of expanding trans-catheter indications, we reviewed our single center experience in the perspective of long-term outcomes.

METHODS: A cohort of 1059 consecutive patients who underwent isolated surgical aortic valve replacement (SAVR) CABG between 2008 and 2013 were reviewed retrospectively. Intervention was a redo in 162 cases (15%). Concomitant CABG was performed in 474 patients (45%, Group I), and SAVR alone in 585 patients (Group II). Pre-0perative variables are depicted in Table I.

RESULTS: Early morbidity rates were not different between Groups I and II. Similarly, early mortality was not significantly different between the 2 groups: 2.95% in Group I vs. 1.54% in Group II (p=0.11) despite a predicted higher mortality in Group I (4%). Using multivariate logistic regression analysis, redo surgery, presence of cardiogenic shock and prior CABG were independent predictors of early mortality, while age, chronic lung disease, and diabetes were predictors for late mortality. During a mean follow-up of 33.1 months, cumulative probability of survival at 5 years (Fig.1) was 76.5% and 81.6% for patients in Group I and II, respectively (p=0.72 after adjusting for differences in baseline values).

CONCLUSIONS: CABG concomitant to SAVR is performed in older patients and increases bypass and cardiac exclusion times, ICU and total length of stay but has no impact on early or late mortality.

Patient characteristics in 1059 cases of SVR with or without CABG
Variable Mean, Group I, SD

n = 475

Mean, Group II, SD

n = 585

p Value
Age, years 73.03 8.68 66.91 13.69 < 0.01
BMI 28.58 5.88 29.29 6055 = 0.07
EF, % 51.38 10.28 51.44 10.07 = 0.9
LOS, days 9.27 7.10 7.60 5.29 < 0.01
ICU Time, Hours 72.37 13.6 49.31 59.2 < 0.01
Perfusion time, min 140.63 54.30 99.20 43.70 < 0.01
X Aortic time, min 108.85 40.49 72.28 34.69 < 0.01