MINIMALLY-INVASIVE AORTIC VALVE REPLACEMENT IN PATIENTS WITH CONCOMMITANT CORONARY ARTERY DISEASE
Alon Aharon1, Matthew Thomas1, Oleg Orlov1, Ioannis Paralikas1, Djamila Abjigitova2, Joshua Wong1, Amber Melvin3, Konstadinos Plestis1.
1lankenau medical center, Philadelphia, PA, USA, 2Erasmus Medical Center, Rotterdam, Netherlands, 3Division of Cardiac Surgery University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: Minimally invasive aortic valve replacement (mAVR) has become the standard of care for isolated aortic valve disease. In patients with asymptomatic one or two vessel coronary artery disease not involving the left main or the ostial left anterior descending coronary artery, isolated mAVR may be a viable option.
We compared the outcomes of mAVR patients with concomitant coronary artery disease to the MIAVR patients without concomitant coronary artery disease
METHODS: From January 2006 to May 2015, 517 patients underwent mAVR at our institution. Sixty nine patients (70% male) had concurrent CAD (>50% stenosis, CAD-group) and 448 patients (58% male) had no CAD (nCAD-group). Mean age was 74.1 years (in the CAD-group vs 68.5 in the nCAD-group (p=0<0.05). There was a higher incidence of hypertension (82.6% vs 71%, p=0.041) and hypercholesterolemia (88.4%vs 62%, p=0<0.05) in the CAD group.
RESULTS: The mean cardiopulmonary bypass and cross-clamp times were 114.9 vs 125 and 86.9 vs 96 minutes for the CAD-group vs nCAD-group respectively.There was no difference in the use of PRBC [2.3 vs 2.1], FFP [0.77 vs. 0.43], PLTS [1 vs. 1] and cryoprecipitate [1.2 vs 1.2 units] in the CAD-group vs nCAD-group respectively.There was no difference in postoperative stroke [2(2.9%) vs 5(1%)], new onset renal insufficiency [5 (7.2 %) vs 18(4%)], and atrial fibrillation [29(33.3%) vs 126(28%)] in CAD-group vs nCAD-group respectively. In-hospital mortality was higher (5.8% vs 2%) in the CAD group (p<0.05). The actuarial survival at 1, 3 and 5 years was 90.87% vs 96.88%, 87.36% vs 93.45% and 74.27% vs 89.57% CAD-group vs nCAD-group respectively (p<0.05)
CONCLUSIONS: Although coronary artery disease did not directly contribute to postoperative mortality, the presence of coronary artery disease had a negative impact both on short and long term survival.
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