HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thoralf M. Sundt, III Suzan F. Murphy Eric N. Mendeloff Charles B. Huddleston Michael K. Pasque William A. Gay, Jr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sundt, T. M. Articles by Gay, W. A. Search for Related Content PubMed PubMed Citation Articles by Sundt, T. M., III Articles by Gay, W. A., Jr Related Collections Related Article

Ann Thorac Surg 1997;64:651-657
© 1997 The Society of Thoracic Surgeons

---

Original Article: Cardiovascular

Previous Coronary Artery Bypass Grafting Is Not a Risk Factor for Aortic Valve Replacement

Division of Cardiothoracic Surgery, Department of Surgery, and Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri

Background. The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR ± CABG and the primary combined procedure.

Methods. Between January 1, 1985, and June 30, 1996, 427 patients underwent primary AVR + CABG, and 52 underwent AVR ± CABG after prior CABG. Demographics, operative characteristics, and operative results were compared between groups. Data for all patients were pooled and analyzed collectively for risk factors influencing mortality.

Results. The extent of native coronary artery disease and the incidence of prior myocardial infarction and stroke were greater in the reoperative group. Aortic cross-clamp and cardiopulmonary bypass times were slightly shorter, and fewer distal anastomoses were performed in the reoperative group. Operative mortality (primary group, 6.3% versus reoperative group, 7.4%) and morbidity were similar. Stepwise multivariate logistic regression analysis identified age, perioperative myocardial infarction, intraaortic balloon support, ventricular arrhythmia, perioperative stroke, and development of renal failure or acute respiratory distress syndrome, but not reoperative status, as predictors of mortality.

Conclusions. The risk of AVR after previous CABG is similar to that for primary AVR + CABG. Valve replacement should, therefore, be pursued despite prior CABG when hemodynamically significant aortic stenosis develops. Furthermore, a circumspect approach to "prophylactic" AVR for mild aortic stenosis at primary CABG seems warranted.

Related Article

Discussion
Ann. Thorac. Surg. 1997 64: 657-658. [Extract] [Full Text]

This article has been cited by other articles:

				B. Sareyyupoglu, T. M. Sundt III, H. V. Schaff, M. Enriquez-Sarano, K. L. Greason, R. M. Suri, H. M. Burkhart, S. J. Park, J. A. Dearani, R. C. Daly, et al. Management of mild aortic stenosis at the time of coronary artery bypass surgery: should the valve be replaced? Ann. Thorac. Surg., October 1, 2009; 88(4): 1224 - 1231. [Abstract] [Full Text] [PDF]

				M. Krane, R. Bauernschmitt, A. Hiebinger, M. Wottke, B. Voss, C. C. Badiu, and R. Lange Cardiac reoperation in patients aged 80 years and older. Ann. Thorac. Surg., May 1, 2009; 87(5): 1379 - 1385. [Abstract] [Full Text] [PDF]

				N. Khaladj, M. Shrestha, S. Peterss, I. Kutschka, M. Strueber, L. Hoy, A. Haverich, and C. Hagl Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete? Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 260 - 264. [Abstract] [Full Text] [PDF]

				P. M. Davierwala, M. A. Borger, T. E. David, V. Rao, M. Maganti, and T. M. Yau Reoperation is not an independent predictor of mortality during aortic valve surgery J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 329 - 335. [Abstract] [Full Text] [PDF]

				G. Shanmugam Aortic valve replacement following previous coronary surgery Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 731 - 735. [Abstract] [Full Text] [PDF]

				H. Hirose, I. S. Gill, and B. W. Lytle Redo-aortic valve replacement after previous bilateral internal thoracic artery bypass grafting Ann. Thorac. Surg., September 1, 2004; 78(3): 782 - 785. [Abstract] [Full Text] [PDF]

				S. C. Gardner, G. K. Grunwald, J. S. Rumsfeld, J. C. Cleveland Jr, L. M. Schooley, D. Gao, F. L. Grover, G. O. McDonald, and A. L. Shroyer Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery Ann. Thorac. Surg., February 1, 2004; 77(2): 549 - 556. [Abstract] [Full Text] [PDF]

				I. Florath, U. P. Rosendahl, A. Mortasawi, S. F. Bauer, F. Dalladaku, I. C. Ennker, and J. C. Ennker Current determinants of operative mortality in 1400 patients requiring aortic valve replacement Ann. Thorac. Surg., July 1, 2003; 76(1): 75 - 83. [Abstract] [Full Text] [PDF]

				M. Nakajima, K. Tsuchiya, Y. Naito, N. Hibino, and H. Inoue How to establish myocardial protection during aortic arch operation in patients with patent left internal thoracic artery graft: Careful dissection or no touch technique? J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1254 - 1255. [Full Text]

				J. G. Byrne, A. N. Karavas, F. Filsoufi, T. Mihaljevic, L. Aklog, D. H. Adams, L. H. Cohn, and S. F. Aranki Aortic valve surgery after previous coronary artery bypass grafting with functioning internal mammary artery grafts Ann. Thorac. Surg., March 1, 2002; 73(3): 779 - 784. [Abstract] [Full Text] [PDF]

				E. A. Tovar, J. R. Sherman, D. M. Weinberg, Y. C. Suh, R. H. Rathod, and A. Borsari Aortoscopy: a less invasive intraoperative method to assess the aortic valve Ann. Thorac. Surg., January 1, 2002; 73(1): 284 - 286. [Abstract] [Full Text] [PDF]

				S. H Rahimtoola VALVE DISEASE: Should patients with asymptomatic mild or moderate aortic stenosis undergoing coronary artery bypass surgery also have valve replacement for their aortic stenosis? Heart, March 1, 2001; 85(3): 337 - 341. [Full Text]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				T. M. Sundt III and W. A. Gay Jr Reply Ann. Thorac. Surg., July 1, 1998; 66(1): 307 - 308. [Full Text] [PDF]

				M. J.R. Dalrymple-Hay, S. A. Sami, S. A. Livesey, and J. L. Monro Previous CABG is not a risk factor for aortic valve replacement Ann. Thorac. Surg., July 1, 1998; 66(1): 307 - 308. [Full Text] [PDF]