Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jul 9;35(2):ivac164.
doi: 10.1093/icvts/ivac164.

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

Alan Gallingani  1 , Stefano D'Alessandro  2 , Gurmeet Singh  3 , Daniel Hernandez-Vaquero  4 , Mevlüt Çelik  5 , Evelina Ceccato  6 , Francesco Nicolini  6   7 , Francesco Formica  6   7
Affiliations
Meta-Analysis

The impact of coronary artery bypass grafting added to aortic valve replacement on long-term outcomes in octogenarian patients: a reconstructed time-to-event meta-analysis

Alan Gallingani et al. Interact Cardiovasc Thorac Surg. .

Abstract

The long-term results in studies comparing octogenarian patients who received either isolated surgical aortic valve replacement (i-SAVR) or coronary artery bypass grafting (CABG) in addition to SAVR are still debated. We performed a reconstructed time-to-event data meta-analysis of studies comparing i-SAVR and CABG+SAVR to evaluate the impact of CABG and to analyse the time-varying effects on long-term outcome. We performed a systematic review of the literature from January 2000 through November 2021, including studies comparing i-SAVR and CABG+SAVR, which reported at least 3-year follow-up and that plotted Kaplan-Meier curves of overall survival. The primary endpoint was overall long-term survival; secondary endpoints were in-hospital/30-day mortality and postoperative outcomes. The pooled hazard ratio (HR) and odds ratio) with 95% confidence interval (CI) were calculated for primary and secondary endpoints, respectively. Random-effect model was used in all analyses. Sixteen retrospective studies were included (5382 patients, i-SAVR = 2568 and CABG+SAVR = 2814). I-SAVR showed a lower incidence of in-hospital mortality compared to CABG+SAVR (odds ratio = 0.73; 95% CI= 0.60-0.89; P = 0.002). Landmark analyses showed a significantly higher all-cause mortality within 1 year from surgery in CABG+SAVR (HR = 1.17; 95% CI = 1.01-1.36; P = 0.03); after 1 year, no significant difference was observed (HR = 0.95; 95% CI = 0.87-1.04; P = 0.35). Landmark analysis was confirmed by time-varying trend of HR. Late survival of octogenarians did not differ significantly between the 2 interventions. Interestingly, CABG added to SAVR was associated with both higher in-hospital and within 1-year mortality after surgery, whereas this difference was statistically non-significant at long-term follow-up.

Keywords: Coronary artery bypass grafting; Meta-analisys; Octogenarians; Surgical aortic valve replacement.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Pooled reconstructed Kaplan–Meier survival curves for long-term survival. Non-difference was reported between the 2 interventions. CABG: coronary artery bypass grafting; CI: confidence interval; HR: hazard ratio; i-SAVR: isolated surgical aortic valve replacement.
Figure 2:
Figure 2:
(A) Kaplan–Meier of failure function of the pooled all-cause mortality. (B) Landmark analysis of all-cause mortality. CABG: coronary artery bypass grafting; HR: hazard ratio; i-SAVR: isolated surgical aortic valve replacement.
Figure 3:
Figure 3:
Hazard ratio trend over time for all-cause mortality estimated by fully parametric survival models. CABG: coronary artery bypass grafting; CI: confidence interval; HR: hazard ratio; i-SAVR: isolated surgical aortic valve replacement.
Figure 4:
Figure 4:
(A) Forest plot for early mortality. Isolated aortic valve replacement (i-SAVR) was associated with lower early mortality compared to coronary artery bypass grafting (CABG)+SAVR. I2, 0.87% indicates no evidence of heterogeneity. CABG: coronary artery bypass grafting; CI: confidence interval; i-SAVR: isolated surgical aortic valve replacement; OR: odd ratio; Sig: P-value; W: weight. (B) Funnel plot to assess publication bias. No publication bias was reported related to early mortality.
None
See this image and copyright information in PMC

Comment in

References

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J. et al.; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021;60:727–800. - PubMed
    1. Chiappini B, Camurri N, Loforte A, Di Marco L, Di Bartolomeo R, Marinelli G.. Outcome after aortic valve replacement in octogenarians. Ann Thorac Surg 2004;78:85–9. - PubMed
    1. Dell'Amore A, Aquino TM, Pagliaro M, Lamarra M, Zussa C.. Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results. Eur J Cardiothorac Surg 2012;41:491–8. - PubMed
    1. Krane M, Voss B, Hiebinger A, Deutsch MA, Wottke M, Hapfelmeier A. et al. Twenty years of cardiac surgery in patients aged 80 years and older: risks and benefits. Ann Thorac Surg 2011;91:506–13. - PubMed
    1. Melby SJ, Zierer A, Kaiser SP, Guthrie TJ, Keune JD, Schuessler RB. et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg 2007;83:1651–6. - PubMed

MeSH terms