Coronary artery bypass grafting after primary isolated aortic valve surgery

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tic valve disease, but survival is strongly related to the presence of coronary artery disease.1,2 In the past decade several less-invasive techniques have emerged in aortic valve surgery. These approaches are associated with reduced sternotomyrelated morbidity, but some may cause injury to one or both internal thoracic arteries (ITAs). The latter could be detrimental to the patient who needs coronary artery bypass grafting (CABG) at an older age, since the ITAs no longer can be used. However, little is known about the need for CABG after primary isolated aortic valve surgery. The goal of the present study was to assess the need for CABG after primary isolated aortic valve surgery and to identify possible predictors of future CABG at the time of the primary operation. Methods. We analyzed data of 1598 patients who had primary isolated aortic valve surgery between 1962 and 1997, excluding those with previous cardiac operations or concomitant procedures during the aortic valve operation that required a median sternotomy. The patient data from 2 centers, the Dijkzigt University Hospital in Rotterdam, The Netherlands (n = 1004), and Cedars-Sinai Medical Center in Los Angeles, California (n = 594), were combined to increase sample size and statistical power and to represent patients from different health care systems. The probability of long-term survival and of receiving a CABG operation were estimated by the method of Kaplan and Meier. In addition, the cumulative actual incidence of CABG was estimated, adjusting for the competing risk of death.3 Results. Preoperative and postoperative variables are displayed in Table I. Total follow-up was 11,102 patient-years. Survival was 97% at 1 month, 94% at 1 year, 85% at 5 years, 66% at 10 years (95% confidence interval [CI] 62%-69%), and 39% at 20 years (95% CI 33%-44%). Only 14 patients required CABG during follow-up. The median time to CABG was 8.8 years; median follow-up in those without CABG was 7.2 years. The actuarial probability of receiving a CABG