Surgical approach of aortic valve disease associated with coronary artery disease Al Hussein Hussam Cernica D.R., Al Hussein S.M., Bud I.T., Ceteras D.M.

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Presentation transcript:

Surgical approach of aortic valve disease associated with coronary artery disease Al Hussein Hussam Cernica D.R., Al Hussein S.M., Bud I.T., Ceteras D.M. Coordinators: Senior Lecturer Liviu Moraru MD. PhD. Professor Horatiu Suciu MD. PhD.

Background The combination between aortic valve stenosis (AoS) and coronary lesions (CAD) represents a particular group of pathology whose severity is given by the association of the left ventricular hypertrophy and reduced blood flow toward the myocardium.

Surgical aortic valve replacement (SAVR) with concomitant coronary artery bypass grafting (CABG) has been the main treatment strategy for patients with severe symptomatic AoS and CAD

Aim To evaluate the surgery results at this category of patients, with increased surgical risk To asses the relationship between treatment strategy and survival, using Kaplan-Meier survival curves To asses the subjective degree of life quality improvement, based on telephone interview

Material and methods We retrospectively reviewed 131 patients with AoS and CAD operated at the Cardiovascular Surgery Clinic from the IBCvT Tîrgu Mures, between January 2010 – December 2013 Was followed up the survival until patients were eliminated because the access to the data base was difficult The 86 patients were divided in two groups: group I – patients with isolated AoS group II – patients with AoS associated with other valvular lesions

Material and methods We analyzed pre-surgical data, surgery details and the postoperative evolution. For the statistic data processing were used Graph Pad and Excell 2010 The accepted statistical significance was p<0,05 for CI 95% To compare the survival curves Kaplan-Meier we used the chi square test

RESULTS Patients’ demographic data

RESULTS

Comparison preoperative-postoperative Ao valve gradient p  0,0001

Comparison preoperative-postoperative Left Ventricule hypertrophy p=0,6192p=0,0026

Surgery details

Kaplan-Meier survival curves p = 0,6522

Deaths frequency Comparative deaths frequency

Quality of life improvement

DISCUSSIONS Our study demonstrated that combined valve surgery with myocardial revascularization has good results, is safe and useful, similar with the results reported by other authors  Payró-Hernández LE 1, Carmona-Jarquín GA, Careaga-Reyna G. Combined coronary artery bypass-graft surgery and valve surgery. Cir Cir Nov-Dec;80(6):   Payró-Hernández LECarmona-Jarquín GACareaga-Reyna G Cir Cir. Alsoufi et all  Results of concomitant aortic valve replacement and coronary artery bypass grafting in the VA population. J Heart Valve Dis Jan;15(1):12-8; discussion  concluded that pre-existing factors such as diabetes, peripheral and cerebral vascular disease, as well as poor preoperative NYHA functional status, affected survival.J Heart Valve Dis. Further investigations are needed to assess the influence of the severity of CAD and associated comorbidities on survival.

Conclusions  The study results proved the efficiency on short and medium term of the surgical treatment, at patients with AoS and associated coronary cardiopathy: Regarding cardiologic parameters Regarding the patients’ life quality

Thank you for your attention !