The effect of coronary ischaemia associated with aortic valve disease: outcome of treatment modalities.

Aortic valve disease is often associated with coronary ischaemic heart disease (CIHD). Surgical aortic valve replacement (SAVR) can be combined with CABG, but its outcome is still a matter for debate, especially when there is postoperative residual ischaemia. Demographic, comorbid, operative variables and postoperative outcome were investigated in patients who underwent SAVR for their distribution across patients with and without CABG. Patients who underwent an associated CABG were more of male gender (970/1520 vs. 481/1018, p < 0.001), octogenarians (440/1520 vs. 241/1018, p = 0.003), needed more urgent surgery (266/1335 vs. 148/913, p = 0.026), but had less prior CABG (110/1518 vs.101/1018, p = 0.017) or SAVR (24/1517 vs. 46/1018, p < 0.001). They also had more cardiopulmonary bypass times > 120 min (705/1255 vs. 102/865, p < 0.001). There was also a higher need for blood transfusion (239/902 vs. 82/614, p < 0.001), prolonged mechanical ventilation (405/900 vs. 184/614, p < 0.001), prolonged stay on the ICU (417/1119 vs. 196/752, p < 0.001) and more postoperative adverse events, including 30-day mortality (93/1520 vs. 44/1018, p = 0.050). Need for urgent SAVR was the dominant predictor, common for both surgical groups. Residual ischaemia was also a predictor for mortality in the CABG group. The association of CABG reduced the 60-month survival rate from 79.9 ± 1.3% to 76.7 ± 0.1% (p = 0.006). The effect of residual ischaemia on survival was stronger (77.2 ± 1.3% versus 67.5 ± 3.7%, p = 0.002). Age above 80 was the dominant predictor for both groups. Need for urgent SAVR had become less important. Residual ischaemia had a clear effect on survival, but was not identified as an independent predictor. The effect of need for urgent SAVR on the outcome suggests that an adequate treatment should not be postponed. In patients with concomitant coronary artery disease, residual ischaemia should be avoided if technically possible.