<p class="first" id="d2716756e127">Coronary artery disease is a common co-morbidity
of aortic stenosis. When needed,
adding coronary artery bypass grafting (CABG) to surgical aortic valve replacement
(SAVR) is the standard treatment method, but the impact of concomitant CABG on long-term
outcomes is uncertain. We compared long-term outcomes of SAVR patients with and without
CABG. Hospital survivors aged ≥50 years discharged after SAVR ± CABG in Finland between
2004 and 2014 (n = 6,870) were retrospectively studied using nationwide registries.
Propensity score matching (1:1) was used to identify patients with comparable baseline
features (n = 2,188 patient pairs, mean age 73 years). The end points were postoperative
10-year major adverse cardiovascular outcome (MACE), all-cause mortality, stroke,
major bleeding, and myocardial infarction. Median follow-up was 6 years. Cumulative
MACE rate (39.5% vs 35.6%; hazard ratio [HR] 1.04; p = 0.677) and mortality (32.7%
vs 31.0%; HR 1.03; p = 0.729) after SAVR were comparable with or without CABG. Myocardial
infarction was more common in patients with CABG (13.4% vs 6.9%; HR 1.47; p = 0.0495).
Occurrence of stroke (15.1% vs 13.5%; p = 0.998) and major bleeding (20.0% vs 21.9%;
p = 0.569) were comparable. There was no difference in gastrointestinal (8.1% vs 10.3%;
p = 0.978) or intracranial bleeds (6.0% vs 5.5%; p = 0.794). The use of internal mammary
artery in CABG did not have an impact on the results. In conclusion, matched patients
with and without concomitant CABG had comparable long-term MACE, mortality, stroke,
and major bleeding rates after SAVR. In conclusion, our results indicate that need
for concomitant CABG has limited impact on long-term outcomes after initially successful
SAVR.
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