Effect of Coronary Artery Disease Extent on Contemporary Outcomes of Combined Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery

Abstract

Concomitant aortic valve replacement (AVR) and coronary artery bypass graft surgery (CABG) is a common procedure. Whether the extent of coronary artery disease (CAD) influences outcomes of AVR plus CABG is unknown. All AVR plus CABG cases from 2008 to 2010 were extracted from the California CABG Outcomes Reporting Program database. Patients with left main coronary artery stenosis greater than 50% or at least three diseased vessels were defined as having extensive CAD, and patients with one or two diseased coronary vessels were defined as having less extensive CAD. Multivariable logistic regression models were developed for predicting major postoperative complications and 30-day mortality. A Cox proportional hazards model was developed to predict the risk of 1-year mortality. Between 2008 and 2010, 6,151 AVR plus CABG were performed in California. Compared with patients with one- or two-vessel CAD, patients with extensive CAD undergoing AVR plus CABG were on average older, more often male, had greater prevalence of multiple comorbidities, and underwent more urgent or emergent operations (all p < 0.05). After adjusting for baseline risk factors, AVR plus CABG with extensive CAD was associated with significantly increased risk of major postoperative complications (adjusted odds ratio, 1.24; 95% confidence interval, 1.10 to 1.40; p= 0.001) but not operative mortality (adjusted odds ratio, 1.00; 95% confidence interval, 0.77 to 1.29; p= 0.978). A Cox proportional hazards model showed that age and other medical comorbidities, but not extensive CAD, were significant risk factors for 1-year mortality. Compared with AVR plus CABG for one- or two-vessel CAD, AVR plus CABG for left main or three or more vessel CAD had higher observed and risk-adjusted rates of postoperative complications but not operative or 1-year mortality.