Does previous valve replacement affect short-term coronary artery bypass grafting outcomes? A population-based National Inpatient Sample study from 2015 to 2020.

Abstract

Background: Coronary artery disease (CAD) and valvular disease frequently coexist due to similar pathophysiology. Effort has been dedicated to comprehending the outcomes of concomitant coronary revascularization and valve replacement procedures. However, the understanding of how prior valve replacement affects the outcomes of coronary artery bypass grafting (CABG) remains limited. Thus, this study aimed to conduct a population-based examination of the in-hospital outcomes in patients with previous valve replacement in CABG.

Methods: Patients who underwent CABG were identified in the National Inpatient Sample in the USA from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between patients with and without previous valve replacement. In-hospital postoperative outcomes were assessed.

Results: There were 514 patients with previous valve replacement who underwent CABG, who were matched to 1588 out of 167,668 controls. After matching, patients with valve replacement had mostly comparable in-hospital outcomes except for a higher risk of vascular complications (1.75 % vs 0.57 %, p = 0.02), a longer length of stay (10.90 ± 7.04 days vs 9.95 ± 6.53 days, p = 0.01), and higher hospital charges (275,465 ± 229,088 US dollars vs 231,648 ± 189,938 US dollars, p < 0.01).

Conclusion: For short-term outcomes, CABG is generally safe for patients who have undergone previous valve replacement, although there is an increased risk of vascular complications that may warrant additional attention. The findings of this study can be valuable for preoperative risk assessment of patients who have had valve replacement and are considering CABG.