Early-term Results of Rapid-Deployment Aortic Valve Replacement versus Sutured Bioprostheses Implantation in Combined Coronary Artery Bypass Grafting

Objectives: Aortic stenosis (AS) is highly prevalent among patients with concomitant coronary artery disease (CAD). Surgical aortic valve replacement with coronary artery bypass grafting is the treatment of choice for patients with severe AS and significant CAD. Aim of this study was to evaluate the outcome and hemodynamic results of rapid-deployment valves (RDAVR) vs sutured valves (SV) in combined surgery.

Methods: Between 01/2012 and 01/2017, a total of 120 patients underwent operation with the RDAVR, 133 patients underwent SV replacement with combined coronary bypass grafts. Clinical and echocardiographic data were compared.

Results: Mean age was 76 ± 7 for RDAVR and 74 ± 6 years for SV (p = 0.054), 48% in the RDAVR group were female versus 17% in the SV group (p = 0.0016). Other characteristics such as diabetes mellitus, BMI, COPD, nicotine consumption and extracardiac arteriopathy were similar. Coronary three-vessel diseases were more common in the RDAVR group (42.5% vs. 27.8%, p = 0.0173). Both, mean EuroSCORE II 7 ± 5 versus 4 ± 3, p = 0.001 and STS-Score 5.4 ± 4.4 versus 3 ± 2, p = 0.001 were significantly higher in the RDAVR group. Mean cross-clamp 82 ± 25 vs 100 ± 30 minute; p = 0.0001 and CPB-time 119 ± 38 vs 147 ± 53 minute; p = 0.0001 were shorter with RDAVR; Mean number of bypass grafts, hospital stay, ICU stay and mechanical ventilation time were equivalent. Hospital mortality was 2.5% for RDAVR and 8.7% for SV (p = 0.0199). There were similar rate of stroke (5.8 vs. 6%, p = 0.99) and postoperative delirium (14.1% vs. 15.8%, p = 0.7). Mean gradients were: 8.2 ± 4.1 in RDAVR vs 11.3 ± 4.6 mm Hg in SV-group (p = 0.001) at discharge.

Conclusion: RDAVR in combined coronary artery bypass grafting can be performed extremely safe. Cross-clamp and cardiopulmonary bypass times can be especially in combination of CABG reduced. RDAVR showed lower gradients compared with SV with the same mean size.

Die Autoren geben an, dass kein Interessenkonflikt besteht.