Mortality and need for reoperation in patients with mild-to-moderate asymptomatic aortic valve disease undergoing coronary artery bypass graft alone

Background Patients presenting for coronary artery bypass graft (CABG) surg ery may have concurrent asymptomatic aortic stenosis (AS) or aortic insuffi ciency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR). Methods study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients with asymptomatic mild-to-moderate AS, Al , or both undergoing CABG but not AVR (CABG group). End points included 30- day mortality rate, time to cardiac mortality, time to all-cause mortality, and time to aortic valve reoperation. Reoperation refers to surgery for re placement of the native aortic valve in the CABG group or replacement of th e prosthetic aortic valve in the AVR-CABG group. important patient characte ristics affecting outcomes were determined by using Cox proportional-hazard analysis. These variables were then included in multivariable analyses by using logistic regression analysis and Cox proportional-hazard modeling to compare outcomes between each patient group. Results No difference was seen in any of the mortality end points between t he CABG group and the AVR-CABG group after controlling for significant diff erences between the groups. However, the need for reoperation for AVR was s ignificantly higher for the CABG group than the AVR-CABG group. For patient s followed for up to 6 years, the estimated need for aortic valve reoperati on was 24.3% in the CABG group versus 3% in the AVR-CABG group. Conclusion On the basis of these results, patients with asymptomatic AS or At should be considered for AVR at the time of CABG.