EARLY AND LATE MORTALITY OF PATIENTS UNDERGOING AORTIC-VALVE REPLACEMENT AFTER PREVIOUS CORONARY-ARTERY BYPASS GRAFT-SURGERY

Background In a small number of patients who undergo coronary artery b ypass graft surgery (CABG), a hemodynamically significant aortic valve lesion requiring aortic valve replacement (AVR) develops as they grow older. In a limited number of studies in small patient groups, high m ortality has been shown in patients undergoing AVR after CABG. We unde rtook this study to determine the mortality risk factors for patients who undergo AVR after CABG procedures. Methods and Results The outcome of 104 patients treated at our institution between January 1983 and D ecember 1993 was retrospectively reviewed. The initial surgery was CAB G in all patients. The patient population included 86 men (83%) and 18 women (17%); their mean age was 67 years. Overall, 70% of patients ha d congestive heart failure, and 96% had multivessel coronary artery di sease. The diagnosis was aortic stenosis in 68% of patients, aortic in sufficiency in 16%, and combined aortic stenosis and aortic insufficie ncy in 16%. Postoperative complications included worsening congestive heart failure (35%), perioperative myocardial infarction (13%), and bl eeding (28%). The early mortality was 14%, and the late mortality was 17% (mean follow-up, 35 months). The risk factors for early mortality were number of diseased vessels (P=.028), renal failure (0.000), and p rior myocardial infarction (P=.028). A perioperative predictor of earl y mortality was cardiopulmonary bypass time (P=.000). The risk factors for late mortality included preoperative diabetes mellitus (P=.007), postoperative acute respiratory distress syndrome (P=.011), and ventri cular arrhythmias (P=.0001). The survival dt 1, 5, and 10 years was 96 %, 75%, and 49%: respectively. Conclusions Risk factors were identifie d for early and late mortality in patients undergoing AVR after previo us CABG. Although early morbidity and mortality were high, the long te rm outcome of the survivors was favorable.