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

This Article Full Text Full Text (PDF) 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): Cary W. Akins Gus J. Vlahakes Thomas E. MacGillivray David F. Torchiana Joren C. Madsen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Akins, C. W. Articles by Madsen, J. C. Search for Related Content PubMed PubMed Citation Articles by Akins, C. W. Articles by Madsen, J. C. Related Collections Valve disease

Ann Thorac Surg 2002;74:1098-1106
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting

^a Cardiac Surgical Unit, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

Accepted for publication May 29, 2002.

* Address reprint requests to Dr Akins, Department of Surgery, White 503, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
e-mail: cakins{at}partners.org

Background. Concomitant coronary artery disease with aortic valve disease is an established risk factor for diminished late survival. This study evaluated the results of bioprosthetic (BAVR) or mechanical aortic valve replacement (MAVR) performed with coronary artery bypass grafting (CABG).

Methods. From January 1984 through July 1997, combined AVR + CABG was performed in 750 consecutive patients; 469 received BAVR and 281 received MAVR. BAVR recipients were significantly older (mean age, 75 vs 65 years), and had more nonelective operations, congestive heart failure, peripheral vascular disease, preoperative intraaortic balloons, lower cardiac indices, more severe aortic stenosis, less aortic regurgitation, and more extensive coronary artery disease.

Results. Early complications included operative mortality, 32 patients (4.3% total: 3.8% BAVR and 5.0% MAVR); perioperative infarction, 10 (1.3%); and perioperative stroke, 22 (2.9%). Significant multivariable predictors of early mortality were age, perioperative infarction or stroke, nonelective operation, operative year, ventricular hypertrophy, and need for intraaortic balloon. Ten-year actuarial survival was 41.7% for all patients. Predicted survival for age- and gender-matched cohorts from the general population versus observed survival were BAVR, 45% versus 36%; MAVR, 71% versus 48% (survival differences BAVR 9% vs MAVR 23%, p < 0.007). Significant multivariable predictors of late mortality included age, congestive failure, perioperative stroke, extent of coronary disease, peripheral vascular disease, and diabetes. Valve type was not significant. Ten-year actuarial freedom from valve-related complications were (BAVR vs MAVR) structural deterioration, 95% versus 100%, p = NS; thromboembolism, 86% versus 84%, p = NS; anticoagulant bleeding, 93% versus 88%, p < 0.005; reoperation, 98% versus 98%, p = NS.

Conclusions. AVR + CABG has diminished late survival despite the type of prosthesis inserted. Although valve type did not predict late mortality, mechanical AVR was associated with worse survival compared with predicted and more valve-related complications due to anticoagulation requirements.

This article has been cited by other articles:

				J P Bagger, M-B Edwards, and K M Taylor Influence of socioeconomic status on survival after primary aortic or mitral valve replacement Heart, February 1, 2008; 94(2): 182 - 185. [Abstract] [Full Text] [PDF]

				G. J. Vlahakes Mechanical Heart Valves: The Test of Time... Circulation, October 16, 2007; 116(16): 1759 - 1760. [Full Text] [PDF]

				A. I. Duncan, J. Lin, C. G. Koch, A. M. Gillinov, M. Xu, and N. J. Starr The Impact of Gender on In-Hospital Mortality and Morbidity After Isolated Aortic Valve Replacement Anesth. Analg., October 1, 2006; 103(4): 800 - 808. [Abstract] [Full Text] [PDF]

				O. Lund and M. Bland Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacement J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 20 - 26. [Abstract] [Full Text] [PDF]

				J. M. Jones, D. Lovell, G. W. Cran, and S. W. MacGowan Impact of coronary artery bypass grafting on survival after aortic valve replacement Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 327 - 330. [Abstract] [Full Text] [PDF]

				I Florath, A Albert, U Rosendahl, T Alexander, I C Ennker, and J Ennker Mid term outcome and quality of life after aortic valve replacement in elderly people: mechanical versus stentless biological valves Heart, August 1, 2005; 91(8): 1023 - 1029. [Abstract] [Full Text] [PDF]