Management of Patients Undergoing Coronary Artery Bypass Graft Surgery with Mild to Moderate Aortic Stenosis

Apostolos Karagounis, Oswaldo Valencia, Venkatachalam Chandrasekaran, John Smith, Stephen Brecker, Marjan Jahangiri
Department of Cardiology and Cardiac Surgery, St. George’s Hospital and Medical School, London, UK
 

Background and aim of the study: The management of patients undergoing coronary artery bypass graft (CABG) surgery with mild to moderate aortic stenosis (AS) remains controversial. The study aim was to examine the outcome in patients with mild to moderate AS undergoing CABG.
Methods: A retrospective analysis was carried out of 200 patients with coronary artery disease requiring CABG and with a peak AS gradient <40 mmHg measured by Doppler echocardiography, between 1990 and 2000. Among patients, 154 underwent isolated CABG (group A) and 46 CABG + aortic valve replacement (AVR) (group B).
Results: Mortality was 2.6% (n = 4) in group A and 6.5% (n = 3) in group B (p = NS). The median AS gradients were 34 and 40 mmHg, respectively. Thirty patients (20%) in group A were in NYHA class III-IV compared to 20 (44%) in group B (p = 0.002).

There was no significant difference in postoperative complications. The mean intensive care unit stay was 2.3 and 2.2 days, respectively (p = NS); median postoperative stay was 6 and 8 days, respectively (p = 0.02). During the median follow up period of 4.2 years no patient in group A required AVR. Nine late deaths occurred in group B, none of which was cardiac-related.
Conclusion: Morbidity and mortality in patients who underwent combined surgery was comparable with that in patients who had isolated CABG. However, none of the patients who underwent only CABG required AVR during the follow up period. It is concluded that patients with mild AS at the time of CABG should not undergo AVR. It is possible that a cut-off AS gradient >40 mmHg should be considered for combined surgery.
The Journal of Heart Valve Disease 2004;13:369-373
 
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