Impact of concomitant coronary artery bypass grafting on in-hospital outcome in octogenarians undergoing aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: Abundant data are available reporting excellent in-hospital outcomes after surgical aortic valve replacement (AVR) in octogenarians. However, there is a paucity of studies reporting the in-hospital outcome of concomitant AVR and coronary artery bypass grafting (CABG) in this group of patients. Hence, a comparison was made of the impact of concomitant AVR and CABG versus isolated AVR on in-hospital outcome in octogenarians. METHODS: Between January 2001 and October 2011, a total of 114 consecutive octogenarians undergoing combined AVR and CABG were compared with a control group of octogenarians (n = 68) undergoing isolated AVR. A retrospective analysis was performed of a prospectively collected cardiac surgery database. In addition, the medical notes and charts of all study patients were reviewed. RESULTS: The two groups had a similar mean age (AVR 82.3 +/- 2.4 years versus AVR + CABG 82.6 +/- 2.1 years; p = 0.91), demographics and EuroSCORE (AVR 11.4 versus AVR + CABG 13.2; p = 0.12). The aortic cross-clamp and cardiopulmonary bypass times were longer for AVR + CABG patients (p < 0.001). In-hospital mortality (7.4% after isolated AVR, 9.6% after AVR + CABG; p = 0.35 between groups) and major clinical outcomes for the two groups were found to be similar except for an increased need for hemofiltration in AVR + CABG patients (p = 0.02). CONCLUSION: In-hospital outcomes for concomitant AVR and CABG in octogenarians are comparable to those of isolated AVR, justifying the performance of combined AVR and CABG in this high-risk group of carefully selected patients.

Impact of technique of left ventricular aneurysm repair on clinical outcomes: current best available evidence.

Postinfarction left ventricular aneurysm is a serious disorder that can lead to congestive heart failure, lethal ventricular arrhythmia, and premature death. Surgical treatment is indicated in established cases of congestive heart failure, angina pectoris, malignant ventricular arrhythmia, or recurrent embolization from the left ventricle. The goal of surgical intervention is to correct the size and geometry of the left ventricle, reduce wall tension and paradoxical movement, and improve systolic function. Surgical techniques for repair of left ventricular aneurysm have evolved over the last five decades. Aneurysmectomy and linear repair of the left ventricle was introduced by Cooley and colleagues in 1958 and remained the standard procedure until the late 1980s. Endoventricular patch plasty (EVPP) was then introduced as a more physiologic repair than the linear closure technique, especially when the aneurysm extends into the septum. However, there is still controversy whether EVPP is superior to simple linear resection in terms of impact on early and late clinical outcomes. In the current era of evidence-based medicine, the best strategy to resolve a controversy is through the explicit and conscientious assessment of current best evidence. This review article attempts to evaluate the current best available evidence on the impact of technique of left ventricular aneurysm repair on postoperative clinical outcomes.