{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:23:11Z","timestamp":1783570991686,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. Methods: The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. Results: There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore &gt; 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation &lt; 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore &lt; 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82\u20135.44, p: 0.01) and risk group of ES &gt; 8 (HR: 3.63, 95% CI: 1.45\u20139.07, p &lt; 0.01) as independent predictors for lower long-term survival. Conclusions: Hospital mortality (30 d) was nearly 2.5-fold higher in female and\/or older than 70 y patients. Preoperative atrial fibrillation and\/ or a calculated ES &gt; 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.<\/jats:p>","DOI":"10.3390\/jcm13010238","type":"journal-article","created":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T06:00:21Z","timestamp":1704002421000},"page":"238","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-258X","authenticated-orcid":false,"given":"Kyriakos","family":"Spiliopoulos","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece"},{"name":"Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5417-6392","authenticated-orcid":false,"given":"Dimitrios","family":"Magouliotis","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Angelis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-2478","authenticated-orcid":false,"given":"John","family":"Skoularigis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard M.","family":"Kemkes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos S.","family":"Salemis","sequence":"additional","affiliation":[{"name":"Breast Cancer Surgery Unit, Army General Hospital, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanos","family":"Athanasiou","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Gansera","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9439-3946","authenticated-orcid":false,"given":"Andrew V.","family":"Xanthopoulos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.jtcvs.2014.08.084","article-title":"Hospital volume, mitral repair rates, and mortality in mitral valve surgery in the elderly: An analysis of US hospitals treating Medicare fee-for-service patients","volume":"149","author":"Vassileva","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/icvts\/ivv132","article-title":"Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: Short- and mid-term outcomes","volume":"21","author":"Davarpasand","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.athoracsur.2006.10.027","article-title":"Aortic valve replacement and concomitant coronary artery bypass: Assessing the impact of multiple grafts","volume":"83","author":"Kobayashi","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jtcvs.2014.08.073","article-title":"The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: Implications for revascularization in the transcatheter era","volume":"149","author":"Thalji","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/j.1540-8191.2009.00906.x","article-title":"EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coro-nary artery bypass patients","volume":"24","author":"Kobayashi","year":"2009","journal-title":"J. Cardiac Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1510\/icvts.2008.183590","article-title":"Sorin Bicarbon bileaflet valve: A 9.8-year experience. Clinical performance of the prosthesis after heart valve replacement in 587 patients","volume":"8","author":"Spiliopoulos","year":"2009","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00380-019-01519-6","article-title":"Does additional coronary artery bypass grafting to aortic valve replacement in elderly patients affect the early and long-term outcome?","volume":"35","author":"Formica","year":"2020","journal-title":"Heart Vessels"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1161\/hc1002.105133","article-title":"Sex differences in hospital mortality after coronary artery bypass surgery: Evidence for a higher mortality in younger women","volume":"105","author":"Vaccarino","year":"2002","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1016\/j.athoracsur.2008.02.082","article-title":"Gender differences in mortality after mitral valve operation: Evidencefor higher mortality in perimenopausal women","volume":"85","author":"Song","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1002\/ccd.27478","article-title":"Outcomes of intermediate-risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20-year experience","volume":"92","author":"Garcia","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s00380-016-0857-3","article-title":"Transcatheter aortic valve replacement in nonagenarians: Early and intermediate outcome from the observant study and meta-analysis of the literature","volume":"32","author":"Biancari","year":"2017","journal-title":"Heart Vessel."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1016\/S0140-6736(16)30073-3","article-title":"Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: A propensity score analysis","volume":"387","author":"Thourani","year":"2016","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.athoracsur.2012.07.075","article-title":"Management of high-risk patients with aortic stenosis and coronary artery disease","volume":"95","author":"Wendt","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijcard.2018.06.011","article-title":"Transcatheter or surgical treatment of severe aortic stenosis and coronary artery disease: A comparative analysys from the Italian OBSERVANT study","volume":"270","author":"Barbanti","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1161\/CIRCULATIONAHA.118.039564","article-title":"Comparison of a complete percutaneous versus surgical approach to aortic valve replacement and revascularization in patients at intermediate surgical risk: Results from the randomized SURTAVI trial","volume":"140","author":"Popma","year":"2019","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s00380-018-1166-9","article-title":"Comparison of midterm outcomes of transcatheter aortic valve implantation in patients with and without previous coronary artery bypass grafting","volume":"33","author":"Kawashima","year":"2018","journal-title":"Heart Vessel."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e005960","DOI":"10.1161\/JAHA.117.005960","article-title":"Transcatheter aortic valve implantation with or without percutaneous coronary artery revascularization strategy: A systematic review and meta-analysis","volume":"6","author":"Kotronias","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Baumbach, H., Schairer, E.R., Wachter, K., Rustenbach, C., Ahad, S., Stan, A., Hill, S., Bramlage, P., Franke, U.F.W., and Sch\u00e4ufele, T. (2019). Transcatheter aortic valve replacement- management of patients with significant coronary artery disease undergoing aortic valve interventions: Surgical compared to catheter-based approaches in hybrid procedures. BMC Cardiovasc. Disord., 19.","DOI":"10.1186\/s12872-019-1087-2"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1136\/heartjnl-2016-311031","article-title":"Mitral valve repair for degenerative mitral valve disease: Surgical approach, patient selection and long-term outcomes","volume":"103","author":"Coutinho","year":"2017","journal-title":"Heart"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1136\/hrt.2005.076109","article-title":"Mitral repair best practice: Proposed standards","volume":"92","author":"Bridgewater","year":"2006","journal-title":"Heart"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1053\/j.jvca.2016.06.032","article-title":"Short- and medium-term effects of combined mitral valve surgery and coronary artery bypass grafting versus coronary artery bypass grafting alone for patients with moderate ischemic mitral regurgitation: A meta-analysis","volume":"30","author":"Wang","year":"2016","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/S0003-4975(03)01071-3","article-title":"Late outcome of mitral valve surgery for patients with coronary artery disease","volume":"76","author":"Dahlberg","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/j.athoracsur.2020.03.009","article-title":"Combined Degenerative Mitral Valve and Coronary Surgery: Early Outcomes and 10-Year Survival","volume":"110","author":"Bruno","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_24","first-page":"443","article-title":"A novel approach to ischemic mitral regurgitation (IMR)","volume":"4","author":"Scoville","year":"2015","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_25","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":"ref_26","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":"ref_27","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.athoracsur.2012.09.012","article-title":"Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day","volume":"95","author":"Ranucci","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/j.jacc.2008.08.031","article-title":"Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: A multicenter analysis","volume":"52","author":"Berger","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/s-2003-42260","article-title":"Urgent or emergent coronary revascularization using bilateral internal thoracic artery after previous clopidogrel antiplatelet therapy","volume":"51","author":"Gansera","year":"2003","journal-title":"Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/238\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:45:03Z","timestamp":1760132703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/1\/238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,30]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13010238"],"URL":"https:\/\/doi.org\/10.3390\/jcm13010238","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,30]]}}}