Influence of coronary bypass grafting on the outcome of aortic valve replacement in the presence of left ventricular dysfunction: The VERDI Surgical study

Background: The impact of coronary artery bypass grafting (CABG) on the results of aortic valve replacement (AVR) in the presence of left ventricular (LV) dysfunction is still poorly defined. This retrospective multiinstitutional study evaluated the long-term results of AVR with or without combined CABG in patients affected by impaired LV contractility. Methods: From January 1990 to December 2000, 257 patients with LV impairment (LVEF <40%) had undergone AVR because of aortic stenosis at 4 different Institutions. Fiftynine patients (Group A) had been submitted to associated CABG, whereas 198 patients (Group B) had had isolated AVR. Both groups were followed-up in terms of POStoperative morbidity and mortality. Kaplan-Meier estimate and logistic regression multivariate analysis were performed to elucidate postoperative results and disclose predictors of unfavoureble late outcome, including patient/prosthesis mismatch (prosthesis size/body surface area). Results: Preoperative patient profile did not differ between the two groups, except for patient age (71±7 in Group A, and 68±11 in Group B -p>0.05-, respectively). Follow-up was 100% complete. No significant difference was found between the two groups in terms of late morbidity and mortality, although a trend (p:0.06) towards a worse survival was shown in patients submitted to AVR+CABG (75% at 5 years and 50% at 8 years in Group A, and 85% and 65% in Group B, respectively). Satisfactory recovery of long-term functional capacity was achieved in both groups. Patient/prosthesis mismatch was not a determinant of unfavourable outcome, whereas older age (p<0.001, hazard retio:4.08. C.I.: 2.05-8.13) represented the only negative predictor in both groups. Conclusions: CABG procedure does not appear to significantly influence postoperative results of AVR in the presence of LV dysfunction. However. elderly patients are at higher risk of unfavourable late outcome whereas patient/prosthesis mismatch does not apparently influence patient survival or recovery of patient functional capacity in this setting.