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Immediate results of aortic valve replacement in patientswith previous aortocoronary bypass surgery

Authors: G.G. Kvaratskheliya, E.U. Asymbekova, E.P. Golubev, R.M. Muratov, I.I. Skopin, S.T. Matskeplishvili, Yu.I. Buziashvili, I.T. Zakaraya

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

Type:  Original Research


DOI: https://doi.org/10.24022/0236-2791-2018-60-4-309-316

For citation: Kvaratskheliya G.G., Asymbekova E.U., Golubev E.P., Muratov R.M., Skopin I.I., Matskeplishvili S.T., Buziashvili Yu.I., Zakaraya I.T. Immediate results of aortic valve replacement in patients with previous aortocoronary bypass surgery. Russian Journal of Thoracic and Cardiovascular Surgery. 2018; 60 (4): 309–16 (in Russ.). DOI: 10.24022/0236-2791-2018-60-4-309-316

Received / Accepted:  17.01.2018/23.01.2018

Keywords: cardiac ischemia aortic valve replacement coronary artery bypass grafting cardiopulmonary bypass aortic valve mitral valve left ventricle coronary arteries

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Abstract

Objective. To evaluate the immediate results of aortic valve replacement in patients who had previously undergone coronary artery bypass grafting (CABG). Material and methods. The data of 38 patients operated in the Bakoulev Center from July 2007 to December 2017 were analyzed. All patients underwent aortic valve replacement (AVR) after previous CABG. The average age was 63.6±1.6 years. Since the first operation of CABG, 6.6±0.8 years passed. The predominance of aortic valve stenosis (42%) was noted. Isolated AVR was performed in 63% of patients.

Results. The total hospital mortality was 7.9%. The causes of death were bleeding, acute heart failure and multiple organ failure. Mean time of сardiopulmonary bypass was 217±18 minutes. Intraoperative iatrogenic injuries were noted in 7.89% of patients. In 55.2% of cases there were complications in the postoperative period. Complications of AVR after CABG are reliably associated with the duration of the operation (p=0.02), the time of cardiopulmonary bypass (p=0.01), the duration of aortic clamping (p=0.01), with the need for repeated aortic valve replacement (p=0.05), intervention on mitral (p=0.05), and tricuspid valves (p=0.05). The presence of a functioning shunt to the right coronary artery in AVR is a favorable factor in the course of the operation (p=0.05). Postoperative complications are more common in patients with dysfunction of aortic valve prostheses and its insufficiency (p=0.01). The EuroSCORE II risk scale predicts postoperative complications better than EuroSCORE and STS (p=0.049).

Conclusion. The implementation of AVR in patients after previous CABG is associated with high risk of lethal and non-lethal complications.
The main risk factors are aortic valve failure, re-prosthesis, intervention in the atrio-ventricular valves, dysfunction of the
shunt to the right coronary artery, prolonged cardiopulmonary bypass and aortic clamping.

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About Authors

  • George G. Kvaratskheliya, Postgraduate, orcid.org/0000-0002-9511-972X;
  • Elmira U. Asymbekova, Dr. Med. Sc., Leading Researcher,orcid.org/0000-0002-5422-2069;
  • Evgeniy P. Golubev, Cand. Med. Sc., Researcher, orcid.org/0000-0003-0507-993;
  • Renat M. Muratov, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0003-3321-9028;
  • Ivan I. Skopin, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0001-7411-202X;
  • Simon T. Matskeplishvili, Dr. Med. Sc., Professor, Academician of RAS, Leading Researcher, orcid.org/0000-0002-5670-167X;
  • Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of RAS, Head of Department;
  • Irakliy T. Zakaraya, Resident Physician

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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