Title: Short Term Outcomes of Coronary Artery Bypass Grafting and Concomitant Valve Procedure: A Retrospective Review
Authors: Dr Amit Kumar Agarwal, Mch CTVS, Dr Kunwar Sidharth Saurabh, Mch CTVS, Dr Ajit Kumar Padhy (Asst. Proff. CTVS), Dr Anubhav Gupta, Professor and H.O.D, Dr Khushwant Popli (Asst Prof)
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.39
Abstract
Introduction
Rheumatic heart disease is the most common etiology for valve replacements in India. Elderly patients presenting for valve replacements may have concomitant coronary artery disease. Various studies have reported an estimated 20-40% prevalence of CAD in patients undergoing valve replacements. Patients for valve replacement with concomitant CAD if left untreated reduces survival[1]. Lytle et al.,[2] observed operative mortality of patients with both CAD and valvular lesion was higher if CAD was left untreated. Karp et.al[1] recommend that complete revascularization is superior to no revascularization in patients with valvular heart disease and CAD. Previous reports have shown higher risk of combined valve and bypass procedures[3] but with the improvements in surgical techniques and myocardial protection strategies, perioperative mortalities have shown a declining trend[4]. In this study, we retrospectively analyzed outcomes of combined procedures done in our institute.
References
- Karp RB, Millis N, Edmunds LH. Coronary artery bypass grafting in the presence of valvular disease. Circulation 1989;79(Suppl I):I-182–4.
- Lytle BW. Impact of CAD on valvular heart surgery. Cardiol Clin 1991;9:301‑
- Flemma RJ, Johnson WD, Lepley D Jr, Auer JE, TectorAJ, Blitz J. Simultaneousvalve replacement and aorta-to-coronarysaphenous vein bypass. Ann ThoracSurg1971;12:163–70.
- Wisoff BG, Fogel R, Weisz D, Garvey J, Hamby R.Combined valve and coronary artery surgery. Ann ThoracSurg 1980;29:440–3.
- Bozbaş H, Yildirir A, Küçük MA, Ozgül A, Atar I, Sezgin A, et al.Prevalence of coronary artery disease in patients undergoing valvularoperation due to rheumatic involvement. Anadolu Kardiyol Derg2004;4:223‑6.
- Morrison GW, Thomas RD, Grimmer SF, Silverton PN, Smith DR. Incidence of coronary artery disease in patients with valvular heart disease. Br Heart J 1980;44:630‑
- Kabbani SS, Bashour TT, Hanna ES, Ellertson D. Risk of combined coronary artery bypass and mitral valve replacement. Tex Heart Inst J 1984;11:348‑51.
- Kirklin JK, Naftel DC, Blackstone EH, Kirklin JW, Brown RC. Risk factors for mortality after primary combined valvular and coronary artery surgery. Circulation 1989;79:I185‑90.
- Mehta RH, Bruckman D, Das S, Tsai T, Russman P, Karavite D, et al. Implications of increased left ventricular mass index on in‑hospital outcomes in patients undergoing aortic valve surgery. J Thorac Cardiovasc Surg 2001;122:919‑28
- Gunay R, Sensoz Y, Kayacioglu I, Tuygun AK, Balci AY, Kisa U, et al. Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery? Interact Cardiovasc Thorac Surg 2009;9:630‑
- Herlitz J, Brandrup‑Wognsen G, Caidahl K, Haglid M, Karlsson BW, Karlsson T, et al. Mortality and morbidity among patients who undergo combined valve and coronary artery bypass surgery: Early and late results. Eur J Cardiothorac Surg 1997;12:836‑
- Folkmann S, Gorlitzer M, Weiss G, Harrer M, Thalmann M, Poslussny P, et al. Quality‑of‑life in octogenarians one year after aortic valve replacement with or without coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 2010;11:750‑
- Kobayashi KJ, Williams JA, Nwakanma L, Gott VL, Baumgartner WA, Conte JV. Aortic valve replacement and concomitant coronary artery bypass: Assessing the impact of multiple grafts. Ann Thorac Surg 2007;83:969‑
- Sirivella S, Gielchinsky I. Results of coronary bypass and valve operations for mitral valve regurgitation. Asian Cardiovasc Thorac Ann 2007;15:396‑
- Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM, Joyce LD, Burkhart HM, Pochettino A, Li Z, Frye RL. The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. The Journal of thoracic and cardiovascular surgery. 2015 Feb 1;149(2):451-60.
- Panda BR, Shankar R, Kuruvilla KT, Philip MA, Thankachen R, Shukla Vet al. Combined mitral and aortic valve replacement for rheumatic heartdisease:fifteen-year follow up and long-term results. J Heart Valve Dis2009;18:170–9.
- Davarpasand T, Hosseinsabet A, Jalali A. Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: shortand mid-term outcomes. Interactive cardiovascular and thoracic surgery. 2015 May 29;21(3):322-8.
- Kay PH, Nunley DL, Grunkemeier GL, Pinson CW, Starr A. Late results of combined mitral valve replacement and coronary bypass surgery. J Am Coll Cardiol 1985;5:29–33.
- Gehlot A, Mullany CJ, Ilstrup D, Schaff HV, Orzulak TA, Morris JJ, et al. Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg 1996;111:1026–36.
Corresponding Author
Dr Khushwant Popli (Asst Prof)
Dept of CTVS VMMC and Safdarjung Hospital New Delhi.110049, India