Background: This multicenter study was undertaken to determine the immediate and long-term outcomes in patients undergoing a primary surgical aortic valve replacement (AVR) who had a previous coronary artery bypass graft surgery with patent grafts. Methods: One hundred and thirteen consecutive patients (mean EuroSCORE II, 10.3 +/- 7.7%, median 8.0%) who underwent first-time isolated AVR after coronary artery bypass grafting (CABG) were the subjects of this multicenter study. The procedure was performed through a full sternotomy in 95.7% of cases, a patent internal mammary artery graft was clamped in 76.6% of patients. The temperature of cardioplegia was <= 12 8 degrees C in 62.8% of patients and systemic temperature was <32 8 degrees C in 23.9% of patients. Results: Thirty-day mortality was 4.4%. Stroke was observed in 8.0% of patients, low cardiac output syndrome in 14.1%, prolonged tracheal intubation in 20.8%, and intensive care unit stay was longer than five days in 19.5% of patients. Among patients with a patent internal mammary graft (91 patients), clamping of this graft (5.7% vs. 0%, p=0.57) was associated with a nonsignificant trend toward increased 30-day mortality. One-, three- and five-year survival rates were 91.5%, 90.4%, and 88.4%, respectively. Conclusions: Patients undergoing isolated AVR after prior CABG have a good immediate and late survival. A history of prior CABG should not be considered an absolute indication for transcatheter AVR.

First-time, isolated surgical aortic valve replacement after prior coronary artery bypass surgery: results from the RECORD multicenter registry

Onorati, Francesco;FAGGIAN, Giuseppe
2014-01-01

Abstract

Background: This multicenter study was undertaken to determine the immediate and long-term outcomes in patients undergoing a primary surgical aortic valve replacement (AVR) who had a previous coronary artery bypass graft surgery with patent grafts. Methods: One hundred and thirteen consecutive patients (mean EuroSCORE II, 10.3 +/- 7.7%, median 8.0%) who underwent first-time isolated AVR after coronary artery bypass grafting (CABG) were the subjects of this multicenter study. The procedure was performed through a full sternotomy in 95.7% of cases, a patent internal mammary artery graft was clamped in 76.6% of patients. The temperature of cardioplegia was <= 12 8 degrees C in 62.8% of patients and systemic temperature was <32 8 degrees C in 23.9% of patients. Results: Thirty-day mortality was 4.4%. Stroke was observed in 8.0% of patients, low cardiac output syndrome in 14.1%, prolonged tracheal intubation in 20.8%, and intensive care unit stay was longer than five days in 19.5% of patients. Among patients with a patent internal mammary graft (91 patients), clamping of this graft (5.7% vs. 0%, p=0.57) was associated with a nonsignificant trend toward increased 30-day mortality. One-, three- and five-year survival rates were 91.5%, 90.4%, and 88.4%, respectively. Conclusions: Patients undergoing isolated AVR after prior CABG have a good immediate and late survival. A history of prior CABG should not be considered an absolute indication for transcatheter AVR.
2014
Aged, Aged 80 and over, Aortic Valve, Constriction, Female, Heart Arrest Induced, Humans, Hypothermia Induced, Male, Mammary Arteries, Middle Aged, Sternotomy, Survival Rate, Time Factors, Treatment Outcome, Coronary Artery Bypass, Heart Valve Prosthesis Implantation, Registries
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/932182
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