Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement? A decision analysis approach to the surgical dilemma

Journal of the American College of Cardiology
William T SmithEric D Peterson

Abstract

This study utilizes Markov decision analysis to assess the relative benefits of prophylactic aortic valve replacement (AVR) at the time of coronary artery bypass graft surgery (CABG). Multiple sensitivity analyses were also performed to determine the variables that most profoundly affect outcome. The decision to perform CABG or concomitant CABG and AVR (CABG/AVR) in asymptomatic patients who need CABG surgery but have mild to moderate aortic stenosis (AS) is not clear-cut. We performed Markov decision analysis comparing long-term, quality-adjusted life outcomes of patients with mild to moderate AS undergoing CABG versus CABG/AVR. Age-specific morbidity and mortality risks with CABG, CABG/AVR, and AVR after a prior CABG were based on the Society of Thoracic Surgeons national database (n = 1,344,100). Probabilities of progression to symptomatic AS, valve-related morbidity, and age-adjusted mortality rates were obtained from available published reports. For average AS progression, the decision to replace the aortic valve at the time of elective CABG should be based on patient age and severity of AS measured by echocardiography. For patients under age 70 years, an AVR for mild AS is preferred if the peak valve gradient is >25 to 30...Continue Reading

References

Jul 15, 1992·The American Journal of Cardiology·P FaggianoC Rusconi
Mar 1, 1990·Journal of the American College of Cardiology·D LindblomH Lundström
Mar 1, 1989·Journal of the American College of Cardiology·C M OttoC L Gardner
Jan 1, 1983·Medical Decision Making : an International Journal of the Society for Medical Decision Making·J R Beck, S G Pauker
Apr 1, 1980·American Heart Journal·M A ChiznerA C deLeon
Dec 20, 1995·JAMA : the Journal of the American Medical Association·B F GageD K Owens
Jul 6, 1995·The New England Journal of Medicine·S C CannegieterE Briët
Jun 1, 1996·The Annals of Thoracic Surgery·A C FioreV L Willman
Oct 9, 1996·JAMA : the Journal of the American Medical Association·L B RussellM C Weinstein
May 22, 1998·The Annals of Thoracic Surgery·J W TamK L Chan
Sep 29, 1998·Current Problems in Cardiology·R A O'Rourke
Apr 30, 1999·The Journal of Thoracic and Cardiovascular Surgery·D S PeterseimD D Glower
Aug 31, 2000·The New England Journal of Medicine·R RosenhekH Baumgartner

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Citations

Jul 5, 2005·Annales de cardiologie et d'angéiologie·C Chauvel
Aug 28, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alec VahanianUNKNOWN European Association for Cardio-Thoracic Surgery (EACTS)
Aug 28, 2012·European Heart Journal·UNKNOWN Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC)Marian Zembala
Jan 21, 2012·The Korean Journal of Thoracic and Cardiovascular Surgery·Won-Chul ChoCheol-Hyun Chung
Jan 8, 2013·The Annals of Thoracic Surgery·Lars G SvenssonMathew R Williams
Sep 22, 2009·The Annals of Thoracic Surgery·Basar SareyyupogluThomas A Orszulak
Feb 6, 2007·The American Journal of Medicine·Ronny AlcalaiDan Gilon
Feb 4, 2012·Journal of the American College of Cardiology·David R HolmesJames D Thomas
Jun 8, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Nassir M ThaljiHartzell V Schaff
Dec 22, 2005·The Annals of Thoracic Surgery·Eric BezonJean A Barra
Dec 13, 2016·JBI Database of Systematic Reviews and Implementation Reports·John Nguyen, Noel Nacpil
Sep 10, 2017·European Heart Journal·Helmut BaumgartnerUNKNOWN ESC Scientific Document Group
Nov 21, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Volkmar FalkUNKNOWN ESC Scientific Document Group
Oct 24, 2006·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·W G DanielF A Flachskampf
Oct 27, 2006·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Christian BruchThomas Wichter
Dec 20, 2008·Anesthesia and Analgesia·Jan N HilberathHolger K Eltzschig
Aug 22, 2006·Expert Review of Cardiovascular Therapy·Nigel E Drury, Samer A M Nashef
Apr 12, 2008·Expert Review of Cardiovascular Therapy·A Pieter KappeteinAd J J C Bogers
Jun 13, 2019·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Bobby YanagawaJan O Friedrich
Sep 4, 2018·Frontiers in Cardiovascular Medicine·Ernest SpitzerNicolas M Van Mieghem
Nov 27, 2007·Expert Review of Cardiovascular Therapy·Hari P ChalikiA Jamil Tajik
Aug 29, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alec VahanianUNKNOWN ESC/EACTS Scientific Document Group
Aug 29, 2021·European Heart Journal·Alec VahanianUNKNOWN ESC Scientific Document Group

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