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Concomitant Bypass Grafts do not Alter Early or Long-term Outcomes of Patients Undergoing Isolated Aortic Valve Replacement
Mark A. Groh1, Steve W. Ely1, Oliver A. Binns1, Alan M. Johnson1, Wendy Westling2, Gerard L. Champsaur2.
1Asheville Heart, Asheville, NC, USA, 2Mission Hospital- Clinical Research, Asheville, NC, USA.

Background. Perceived increased risk in patients requiring coronary artery bypass grafting (CABG) during surgical aortic valve replacement (SAVR) has led some to advocate a hybrid approach with percutaneous coronary intervention (PCI) and SAVR as an advantage over CABG with SAVR. We reviewed our current long term outcomes in patients undergoing SAVR with and without CABG to assess the contemporary risk in these patients. Methods. A cohort of 956 consecutive patients who underwent SAVR ± CABG between January, 2008 and June, 2013 were retrospectively reviewed. Intervention was a redo in 152 cases (16%). Other variables are depicted in Table I. Concomitant CABG was performed in 442 patients (46%, Group I), and AVR alone in 514 patients (Group II). Results. Early preoperative morbidity was not statistically different between Groups I and II: atrial fibrillation, prolonged ventilation, renal failure, reoperation for bleeding, and TIA. Only stroke rate was higher in Group I receiving CABG (1.75% vs. 0.19%, p<0.01). Mortality was not significantly different between the 2 groups: 2.94% in Group I and 1.56% in Group II (p=0.13) despite a predicted higher mortality in Group I. Using multivariate logistic regression analysis, redo surgery, presence of cardiogenic shock and higher trans-aortic gradient 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 (Kaplan-Meier, Fig.1 ) was 76.9% and 81.6% for patients in Group I and II, respectively (Log-Rank test: p=0.47). Conclusions. When considering revascularization in patients undergoing SAVR, CABG does increase bypass and cardiac exclusion times, as well as ICU and total length of stay. However, early and late mortality are not significantly altered by a single surgical procedure combining SAVR and CABG, with excellent long term durability

Patient characteristics in 956 cases of SVR with or without CABG
VariableMean, GroupI, SVR+CABGMean, Group II, SVR alonep value
Age, years72.866.35<0.01
EF, %51.2251.650.5
LOS, days9.287.58<0.01
MPG, mmHg41.4547.61<0.01
Perfus. time, min140.3498.89<0.01
XClamp. time, min108.6771.89<0.01
Expected mortality0.0424 CI 0.0378-0.0470.0263 CI 0.0238-0.029<0.01

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