Abstract
Background
Combined aortic valve replacement（AVR）and coronary artery bypass grafting（CABG）is mostly performed for
patients with aortic stenosis（AS）and coronary artery disease（CAD）.
Objectives
We aim to clarify that combined operation of AVR and CABG with adequate perioperative cardiac protection does not increase operative and postoperative risk.
Methods
A total of 217 patients who underwent AVR for aortic stenosis alone or combined AVR and CABG from 1/2002 to 12/2015 were recruited. The aortic valve alone group（group A）had 164 patients, with an average age of 71.6±
8.1 years. The combined operation group（group C）consisted of 54 patients, with an average age of 73.5±8.5 years. Aortic valve area and pressure gradient showed no significant differences between the two groups. In group C, an average of 2 ±0.8 vessels had CAD. Cold crystalloid cardioplegia according to left ventricular mass ± a terminal hot shot was used for all patients. Distal graft anastomosis was done after cardiac arrest and cardioplegia（1.5-fold normal）was injected additionally from the graft with severe proximal obstruction of the right coronary artery.
Results
Group C included more patients with diabetes mellitus（DM, 43.4% vs. 26.8%）and low left ventricular ejection fraction（LVEF<50%, 33.96% vs. 16.46%）than group A. On the other hand, the incidence of atrial fibrillation（AF, 3.77% vs. 13.41%）was significantly less in group C than in group A. Although cardiac arrest time was longer in group C, postoperative CPK-MB was not significantly elevated, except in 4 patients. Postoperative data showed no significant differences between the two groups.
Conclusions
In our department, satisfactory clinical outcomes were obtained with combined operation AVR and CABG. Sufficient myocardial protection had an important effect on clinical outcomes.
