Prognostic Impact of Untreated Chronic Coronary Artery Obstruction After Surgery for Aortic Regurgitation

TL;DR

This study finds that moderate coronary artery blockage does not worsen surgical outcomes or survival in patients undergoing aortic valve surgery for aortic regurgitation.

Contribution

The study provides evidence that untreated 50–70% coronary stenosis does not increase adverse outcomes after aortic valve surgery for AR.

Findings

No differences in perioperative mortality or complications between groups with <50% and 50–70% coronary stenosis.

50–70% coronary obstruction was not linked to increased MACE or all-cause mortality over 2.53 years of follow-up.

Abstract

Background: The optimal management strategy for 50–70% chronic coronary artery stenosis in patients undergoing aortic valve surgery for aortic regurgitation (AR) remains controversial. This study evaluates the prognostic impact of chronic coronary obstruction severity on surgical outcomes and mid-term survival. Methods: This retrospective cohort study included 717 patients undergoing aortic valve surgery for AR, grouped by coronary stenosis into <50% (n = 641) and 50–70% (n = 76). Following 1:1 propensity score matching (72 patients per group), the primary outcome of major adverse cardiovascular events (MACE) and the secondary outcome of all-cause death were compared. Results: No intergroup differences emerged in perioperative mortality (1.32% vs. 1.56%, p = 1.000) or complication rate. With a median follow-up of 2.53 years, 50–70% coronary obstruction does not increase MACE (HR = 2.050; 95% CI 0.375–11.197; log-rank p = 0.397) and all-cause mortality (HR = 0.710; 95% CI 0.200–2.522; log-rank p = 0.595). Similar results were obtained in the competing risk regression and multivariable analyses. Conclusions: In patients with AR, 50–70% chronic coronary obstruction does not increase perioperative complications, MACE, and all-cause mortality.

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