{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:22:26Z","timestamp":1793330546896,"version":"4.5.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"British Heart Foundation and NIHR Biomedical Research Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Concomitant revascularization of coronary artery disease at the same time as treatment for aortic valvopathy favourably impacts survival. However, combined surgery may be associated with increased adverse outcomes compared to aortic valve replacement (AVR) or coronary artery bypass grafting in isolation.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We retrospectively analyzed all patients who underwent AVR with bypass grafting between February 1996 and March 2019 using data from the National Adult Cardiac Surgery Audit. We used a generalized mixed-effects model to assess the effect of the number and type of bypass grafts associated with surgical AVR on in-hospital mortality, postoperative stroke, and the need for renal dialysis. Furthermore, we conducted an international cross-sectional survey of cardiac surgeons to explore their views about concomitant AVR with coronary bypass grafting interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Fifty-one thousand two hundred and seventy-two patients were included in the study. Patients receiving 2 or more bypass grafts demonstrated more significant preoperative comorbidity and disease severity. Patients undergoing 2 and &amp;gt;2 grafts in addition to AVR had increased mortality as compared to patients undergoing AVR and only 1 graft [odds ratio (OR) 1.17, 95% confidence interval (CI) [1.05\u20131.30], P\u2009=\u20090.005 and OR 1.15, 95% CI [1.02\u20131.30], P\u2009=\u20090.024 respectively]. A single arterial conduit was associated with a reduction in mortality (OR 0.75, 95% CI [0.68\u20130.82], P\u2009&amp;lt;\u20090.001) and postoperative dialysis (OR 0.87, 95% CI [0.78\u20130.96], P\u2009=\u20090.006), but this association was lost with &amp;gt;1 arterial conduit. One hundred and three surgeons responded to our survey, with only a small majority believing that the number of bypass grafts can influence short- or long-term postoperative outcomes in these patients, and an almost equal split in responders supporting the use of staged or hybrid interventions for patients with concomitant pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The number of grafts performed during combined AVR and coronary artery bypass grafting is associated with increased morbidity and mortality. The use of an arterial graft was also associated with reduced mortality. Future studies are needed to assess the effect of incomplete revascularization and measure long-term outcomes. Based on our data, current published evidence, and the collective expert opinion we gathered, we endorse future work to investigate the short and long-term efficacy and safety of hybrid intervention for patients with concomitant advanced coronary and aortic valve disease.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezad259","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T14:13:19Z","timestamp":1689689599000},"source":"Crossref","is-referenced-by-count":11,"title":["Trends and outcomes of concomitant aortic valve replacement and coronary artery bypass grafting in the UK and a survey of practices"],"prefix":"10.1093","volume":"64","author":[{"given":"Daniel P","family":"Fudulu","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2209-0559","authenticated-orcid":false,"given":"Georgia R","family":"Layton","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester , Leicester, UK"},{"name":"Department of Cardiac Surgery, University Hospitals of Leicester , Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Derriford Hospital , Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8554-6704","authenticated-orcid":false,"given":"Shubhra","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Dimagli","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Guida","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Abbasciano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Imperial College, Hammersmith Hospital , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Viviano","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Imperial College, Hammersmith Hospital , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1753-3730","authenticated-orcid":false,"given":"Gianni D","family":"Angelini","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Zakkar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester , Leicester, UK"},{"name":"Department of Cardiac Surgery, University Hospitals of Leicester , Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"2023101713311817600_ezad259-B1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1093\/icvts\/ivab320","article-title":"Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series","volume":"34","author":"Jones","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2023101713311817600_ezad259-B2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ijso.2019.11.004","article-title":"Outcome of combined coronary artery bypass grafting and aortic valve replacement; a case series","volume":"21","author":"Ahmed","year":"2019","journal-title":"Int J Surg Open"},{"key":"2023101713311817600_ezad259-B3","first-page":"430","article-title":"Prognosis of valve replacement for aortic stenosis with or without coexisting coronary heart disease: a comparative study","volume":"2","author":"Iung","year":"1993","journal-title":"J Heart Valve Dis"},{"key":"2023101713311817600_ezad259-B4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/S0735-1097(87)80161-4","article-title":"Coronary artery disease and its management: influence on survival in patients undergoing aortic valve replacement","volume":"10","author":"Mullany","year":"1987","journal-title":"J Am Coll Cardiol"},{"key":"2023101713311817600_ezad259-B5","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.amjcard.2009.07.059","article-title":"Comparison of the results of aortic valve replacement with or without concomitant coronary artery bypass grafting in patients with left ventricular ejection fraction &lt; or =30% versus patients with ejection fraction &gt;30%","volume":"104","author":"Chikwe","year":"2009","journal-title":"Am J Cardiol"},{"key":"2023101713311817600_ezad259-B6","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.athoracsur.2006.09.051","article-title":"Risk index for predicting in-hospital mortality for cardiac valve surgery","volume":"83","author":"Hannan","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2023101713311817600_ezad259-B7","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.athoracsur.2007.11.074","article-title":"Do we need separate risk stratification models for hospital mortality after heart valve surgery?","volume":"85","author":"van Gameren","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2023101713311817600_ezad259-B8","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivac164","article-title":"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","volume":"35","author":"Gallingani","year":"2022","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023101713311817600_ezad259-B9","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1056\/NEJMoa1803538","article-title":"Five-year outcomes with PCI guided by fractional flow reserve","volume":"379","author":"Xaplanteris","year":"2018","journal-title":"N Engl J Med"},{"key":"2023101713311817600_ezad259-B10","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1056\/NEJMoa1910555","article-title":"Five-year outcomes of transcatheter or surgical aortic-valve replacement","volume":"382","author":"Makkar","year":"2020","journal-title":"N Engl J Med"},{"key":"2023101713311817600_ezad259-B11","doi-asserted-by":"crossref","first-page":"100131","DOI":"10.1016\/j.lanepe.2021.100131","article-title":"Decade-long trends in surgery for acute type A aortic dissection in England: a retrospective cohort study","volume":"7","author":"Benedetto","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"2023101713311817600_ezad259-B12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1001\/jamainternmed.2016.6936","article-title":"National registry data and record linkage to inform postmarket surveillance of prosthetic aortic valve models over 15 years","volume":"177","author":"Hickey","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2023101713311817600_ezad259-B13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/01621459.1993.10594284","article-title":"Approximate Inference in Generalized Linear Mixed Models","volume":"88","author":"Breslow","year":"1993","journal-title":"J Am Stat Assoc"},{"key":"2023101713311817600_ezad259-B14","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Development Core Team","year":"2010"},{"key":"2023101713311817600_ezad259-B15","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/eurheartj\/ehab504","article-title":"Sex differences in outcomes after coronary artery bypass grafting: a pooled analysis of individual patient data","volume":"43","author":"Gaudino","year":"2021","journal-title":"Eur Heart J"},{"key":"2023101713311817600_ezad259-B16","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000330133","article-title":"Does patient gender affect outcomes after concomitant coronary artery bypass graft and aortic valve replacement? An Australian Society of Cardiac and Thoracic Surgeons Database study","volume":"119","author":"Saxena","year":"2011","journal-title":"Cardiology"},{"key":"2023101713311817600_ezad259-B17","doi-asserted-by":"crossref","first-page":"e013260","DOI":"10.1161\/JAHA.119.013260","article-title":"Sex differences in long-term survival after major cardiac surgery: a population-based cohort study","volume":"8","author":"Johnston","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2023101713311817600_ezad259-B18","author":"Ireland SfCSiGBa","year":"2021"},{"key":"2023101713311817600_ezad259-B19","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.jcmg.2021.11.030","article-title":"Bypass grafting and native coronary artery disease activity","volume":"15","author":"Kwiecinski","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"2023101713311817600_ezad259-B20","doi-asserted-by":"crossref","first-page":"e006368","DOI":"10.1161\/CIRCINTERVENTIONS.117.006368","article-title":"Six-year follow-up of fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery","volume":"11","author":"Fournier","year":"2018","journal-title":"Circ Cardiovasc Interv"},{"key":"2023101713311817600_ezad259-B21","doi-asserted-by":"crossref","DOI":"10.1093\/ehjci\/ehaa946.1474","article-title":"Fractional flow reserve (FFR) guided vs angiography guided coronary artery bypass graft (CABG): a systematic review and meta-analysis","volume":"41","author":"Bruno","year":"2020","journal-title":"Eur Heart J"},{"key":"2023101713311817600_ezad259-B22","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.athoracsur.2015.09.100","article-title":"The Society of Thoracic Surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting","volume":"101","author":"Aldea","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2023101713311817600_ezad259-B23","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jacc.2004.09.050","article-title":"Staged initial percutaneous coronary intervention followed by valve surgery (\u201chybrid approach\u201d) for patients with complex coronary and valve disease","volume":"45","author":"Byrne","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2023101713311817600_ezad259-B24","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1016\/j.athoracsur.2015.01.028","article-title":"Feasibility and early safety of single-stage hybrid coronary intervention and valvular cardiac surgery","volume":"99","author":"George","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2023101713311817600_ezad259-B25","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.athoracsur.2013.10.114","article-title":"The STS AVR+CABG composite score: a report of the STS Quality Measurement Task Force","volume":"97","author":"Shahian","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2023101713311817600_ezad259-B26","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/ejcts\/ezab391","article-title":"Coronary artery bypass surgery in the UK, trends in activity and outcomes from a 15-year complete national series","volume":"61","author":"Ohri","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023101713311817600_ezad259-B27","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jtcvs.2011.11.008","article-title":"Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease","volume":"144","author":"Santana","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023101713311817600_ezad259-B28","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/ejcts\/ezy289","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"55","author":"Sousa-Uva","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023101713311817600_ezad259-B29","doi-asserted-by":"crossref","first-page":"e046491","DOI":"10.1136\/bmjopen-2020-046491","article-title":"Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database","volume":"11","author":"Jahangiri","year":"2021","journal-title":"BMJ Open"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezad259\/50904776\/ezad259.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/4\/ezad259\/52189710\/ezad259.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/64\/4\/ezad259\/52189710\/ezad259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T10:56:34Z","timestamp":1729767394000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezad259\/7225851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,18]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,10,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezad259","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,10,1]]},"published":{"date-parts":[[2023,7,18]]},"article-number":"ezad259"}}