Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients

Kyriakos Spiliopoulos; Dimitrios Magouliotis; Ilias Angelis; John Skoularigis; Bernhard M Kemkes; Nikolaos S Salemis; Thanos Athanasiou; Brigitte Gansera; Andrew V Xanthopoulos

doi:10.3390/jcm13010238

Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients

J Clin Med. 2023 Dec 30;13(1):238. doi: 10.3390/jcm13010238.

Authors

Kyriakos Spiliopoulos^{1

2}, Dimitrios Magouliotis¹, Ilias Angelis², John Skoularigis³, Bernhard M Kemkes², Nikolaos S Salemis⁴, Thanos Athanasiou¹, Brigitte Gansera², Andrew V Xanthopoulos³

Affiliations

¹ Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece.
² Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany.
³ Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece.
⁴ Breast Cancer Surgery Unit, Army General Hospital, 11525 Athens, Greece.

Abstract

Objective: The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives.

Methods: The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery.

Results: There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival.

Conclusions: Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.

Keywords: coronary artery bypass grafting; hybrid procedures; minimal invasive techniques; mortality analysis; valve replacement.

Grants and funding

This research received no external funding.