AORTIC-VALVE SURGERY FOLLOWING PREVIOUS CORONARY-ARTERY BYPASS-GRAFTING IMPACT OF CALCIFICATION AND LEAFLET MOVEMENT

We reviewed the reports of 27 patients who had an aortic valve replace ment after previous coronary artery bypass grafting. The aortic valve disease - mainly aortic stenosis - showed a rapid rate of progression. In the time interval between coronary artery bypass grafting and aort ic valve replacement of 4.6+/-2.2 years the peak-to-peak pressure grad ient of the aortic valve rose from 20.2+/-14.3 to 63.0+/-22.7 mmHg, As there is a great interest to identify the patients with a high risk o f a rapid progression because of a high mortality of an aortic valve r eplacement as the second cardiac operation following a coronary artery bypass grafting we also reviewed the cardiac catheterisation films an d found a high incidence of calcification and impaired aortic valve mo tion (81.5% of the patients had already calcified aortic valves and 81 .5% had a impaired valve motion) at the time of coronary artery bypass grafting. We concluded that if a patient has to be operated for coron ary artery disease an aortic valve replacement should be considered no t only according to hemodynamic criteria but also when the aortic valv e is calcified or its leaflets' motion is impaired. (C) 1998 Elsevier Science Ireland Ltd.