SAFETY OF REMOTE AORTIC-VALVE REPLACEMENT AFTER PRIOR CORONARY-ARTERYBYPASS-GRAFTING

Background. A previous coronary artery bypass grafting (CABG) procedur e may complicate subsequent aortic valve replacement (AVR). However, t he operative risks and long-term outcome of patients who undergo these two procedures remain poorly defined. Methods. The medical records of all patients undergoing AVR between February 1986 and September 1995 were reviewed retrospectively. The patients selected for analysis had previously undergone CABG. Results. We performed AVR in 23 consecutive patients who had previously undergone CABG (mean number of grafts, 2. 8). The AVR was performed an average of 7.6 years after CABG (range, 2 to 17 years). There were 20 men and 3 women, with a mean age of 69 ye ars (range, 56 to 85 years). Twenty patients were operated upon for ao rtic stenosis (mean gradient 54 mm Hg, mean valve area 0.7 cm(2)), and 3 patients underwent operation for aortic regurgitation. The average aortic valve gradient at the initial revascularization operation was 8 mm Hg (range, 0 to 29 mm Hg). There was no correlation between the ao rtic valve gradient at the initial revascularization and the interval between CABG and AVR. At the second operation, AVR was performed alone in 11 patients, combined with repeat CABG in 11 patients (mean number of grafts, 1.4), and with mitral valve replacement in 1 patient. A me chanical prosthesis was selected in 14 patients, and a bioprosthesis w as used in 9 patients. There were no perioperative deaths. There were five late deaths at an average follow-up of 44 months. The 5-year actu arial survival was 71%. Conclusions. Previous CABG poses added technic al challenges at the time of reoperation for AVR. The operation can be performed safely, with the expectation of satisfactory long-term surv ival.