Aortic Valve Replacement with or Without Coronary Artery Bypass Grafting : Queen Alia Heart Institute Experience

Abstract

Objective: Our study was designed to compare the outcome of aortic valve replacement with or without coronary artery bypass grafting at Queen Alia Heart Institute with internationally published data. Method: This was a retrospective single-center analysis which looked at patients who underwent aortic valve replacement with or without coronary artery bypass grafting at Queen Alia Heart Institute over a one year period from January 2011 till December 2011. Patients’ demographic characteristics, risk factors for coronary artery disease, preoperative symptoms, left ventricular ejection fraction, hospital stay, complications (in hospital and at 30 days mortality) were reviewed. Results: A total of 193 patients were included in this analysis. Age ranged from 12-75 years with a mean of 53.2 (SD 12.2) years. Eighty three patients had aortic valve replacement alone using a prosthetic valve, while 11 had a tissue valve. The average number of grafts was 2.5 per patient. Surgical on pump time was an average of 104 minutes. Patients who had only AVR had on pump time of an average of 60 minutes, while patients who had combined AVR with CABG had an average on pump time of 128 minutes (P ≤ 0.005). Patients who only had CABG had an average of on pump time of 45 minutes. Hospital stay averaged 10.2 days. Patients who only had AVR stayed for an average of 7.2 days while patients who had AVR and CABG stayed for an average of 10.5 days (P ≤ 0.005). Patients who had CABG stayed on average for 5.8 days, 29 (15%) developed post operative atrial fibrillation, 12 (6.2%) had wound infection, five (2.6%) had pleural effusion, two (1.0%) needed permanent pacemaker, one (0.5%) developed acute renal failure but did not need haemodialysis, nine (4.7%) needed reopening and six (3.1%) had a thrombo-embolic event. Overall in hospital mortality was 4.1% (n=8). No deaths were recorded at 30 day follow up. Conclusion: Aortic valve replacement alone or in combination with coronary artery bypass grafting surgery and/or other valve surgery remains a major challenging procedure and the more complex the procedure by combining (AVR and CABG and/or MVR) the longer the hospital stay with higher morbidity and mortality rate. Queen Alia Heart Institute data are similar to the internationally comparable published data.