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DOI: 10.1055/s-0033-1357083
Impact of Smoking Status on Outcomes after Concomitant Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery
Publication History
15 April 2013
07 August 2013
Publication Date:
25 October 2013 (online)
![](https://www.thieme-connect.de/media/thoracic/201401/lookinside/thumbnails/10.1055-s-0033-1357083-1.jpg)
Abstract
Background There is a paucity of data on the impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft (AVR-CABG) surgery.
Methods Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were nonsmokers, previous smokers, and current smokers using chi-square test and t-test. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively.
Results Concomitant AVR-CABG surgery was performed in 2,563 patients; smoking status was recorded in 2,558 (99.8%) patients. Of these, 1,052 (41.1%) patients had no previous smoking history, 1,345 (52.6%) patients were previous smokers, and 161 (6.3%) patients were current smokers. The 30-day mortality rate was 3.5% in nonsmokers, 4.1% in previous smokers, and 3.1% in current smokers (p = nonsignificant). The incidence of perioperative complications was similar in the three groups. The mean follow-up period for this study was 36 months (range, 0–105 months). After adjusting for differences in patient variables, the incidence of late mortality was higher in previous smokers (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14–1.81; p = 0.002) compared with nonsmokers. A trend toward increased late mortality in current smokers was noted (HR, 1.34; 95% CI, 0.86–2.08; p = 0.201).
Conclusion Smoking is not associated with adverse outcomes after concomitant AVR-CABG surgery. Smoking status should not, therefore, preclude these patients from undergoing this procedure. Given the adverse effect of smoking on overall cardiovascular morbidity and mortality and late postoperative mortality, patients should be encouraged to quit smoking.
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References
- 1 Brunvand H, Offstad J, Nitter-Hauge S, Svennevig JL. Coronary artery bypass grafting combined with aortic valve replacement in healthy octogenarians does not increase postoperative risk. Scand Cardiovasc J 2002; 36 (5) 297-301
- 2 Gulbins H, Malkoc A, Ennker J. Combined cardiac surgical procedures in octogenarians: operative outcome. Clin Res Cardiol 2008; 97 (3) 176-180
- 3 Tsai TP, Matloff JM, Chaux A , et al. Combined valve and coronary artery bypass procedures in septuagenarians and octogenarians: results in 120 patients. Ann Thorac Surg 1986; 42 (6) 681-684
- 4 Ashraf SS, Shaukat N, Odom N, Keenan D, Grotte G. Early and late results following combined coronary bypass surgery and mitral valve replacement. Eur J Cardiothorac Surg 1994; 8 (2) 57-62
- 5 Kobayashi KJ, Williams JA, Nwakanma LU , et al. EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coronary artery bypass patients. J Card Surg 2009; 24 (6) 637-643
- 6 Magovern JA, Pennock JL, Campbell DB , et al. Aortic valve replacement and combined aortic valve replacement and coronary artery bypass grafting: predicting high risk groups. J Am Coll Cardiol 1987; 9 (1) 38-43
- 7 Maslow A, Casey P, Poppas A, Schwartz C, Singh A. Aortic valve replacement with or without coronary artery bypass graft surgery: the risk of surgery in patients > or =80 years old. J Cardiothorac Vasc Anesth 2010; 24 (1) 18-24
- 8 Stassano P, Di Tommaso L, Vitale DF , et al. Aortic valve replacement and coronary artery surgery: determinants affecting early and long-term results. Thorac Cardiovasc Surg 2006; 54 (8) 521-527
- 9 Alsoufi B, Karamlou T, Slater M, Shen I, Ungerleider R, Ravichandran P. Results of concomitant aortic valve replacement and coronary artery bypass grafting in the VA population. J Heart Valve Dis 2006; 15 (1) 12-18 , discussion 18–19
- 10 Gangemi JJ, Kron IL, Ross SD, Tribble CG, Kern JA. The safety of combined cardiac and vascular operations: how much is too much?. Cardiovasc Surg 2000; 8 (6) 452-456
- 11 Gunay R, Sensoz Y, Kayacioglu I , et al. Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?. Interact Cardiovasc Thorac Surg 2009; 9 (4) 630-634
- 12 Karp RB, Mills N, Edmunds Jr LH. Coronary artery bypass grafting in the presence of valvular disease. Circulation 1989; 79 (6 Pt 2) I182-I184
- 13 Kobayashi KJ, Williams JA, Nwakanma L, Gott VL, Baumgartner WA, Conte JV. Aortic valve replacement and concomitant coronary artery bypass: assessing the impact of multiple grafts. Ann Thorac Surg 2007; 83 (3) 969-978
- 14 Christenson JT, Aeberhard JM, Badel P , et al. Adult respiratory distress syndrome after cardiac surgery. Cardiovasc Surg 1996; 4 (1) 15-21
- 15 Jones R, Nyawo B, Jamieson S, Clark S. Current smoking predicts increased operative mortality and morbidity after cardiac surgery in the elderly. Interact Cardiovasc Thorac Surg 2011; 12 (3) 449-453
- 16 Al-Sarraf N, Thalib L, Hughes A, Tolan M, Young V, McGovern E. Effect of smoking on short-term outcome of patients undergoing coronary artery bypass surgery. Ann Thorac Surg 2008; 86 (2) 517-523
- 17 Ashraf MN, Mortasawi A, Grayson AD, Oo AY. Effect of smoking status on mortality and morbidity following coronary artery bypass surgery. Thorac Cardiovasc Surg 2004; 52 (5) 268-273
- 18 Dinh DT, Lee GA, Billah B, Smith JA, Shardey GC, Reid CM. Trends in coronary artery bypass graft surgery in Victoria, 2001-2006: findings from the Australasian Society of Cardiac and Thoracic Surgeons database project. Med J Aust 2008; 188 (4) 214-217
- 19 Saxena A, Dinh DT, Yap CH , et al. Critical analysis of early and late outcomes after isolated coronary artery bypass surgery in elderly patients. Ann Thorac Surg 2011; 92 (5) 1703-1711
- 20 Turan A, Mascha EJ, Roberman D , et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114 (4) 837-846
- 21 Aune E, Endresen K, Roislien J, Hjelmesaeth J, Otterstad JE. The effect of tobacco smoking and treatment strategy on the one-year mortality of patients with acute non-ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2010; 10: 59
- 22 Klein LW, Nathan S. Coronary artery disease in young adults. J Am Coll Cardiol 2003; 41 (4) 529-531
- 23 Gardner SC, Grunwald GK, Rumsfeld JS , et al. Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery. Ann Thorac Surg 2004; 77 (2) 549-556
- 24 Tjang YS, van Hees Y, Körfer R, Grobbee DE, van der Heijden GJ. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg 2007; 32 (3) 469-474
- 25 Pereira JJ, Balaban K, Lauer MS, Lytle B, Thomas JD, Garcia MJ. Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery. Am J Med 2005; 118 (7) 735-742
- 26 Utley JR, Leyland SA, Fogarty CM , et al. Smoking is not a predictor of mortality and morbidity following coronary artery bypass grafting. J Card Surg 1996; 11 (6) 377-384 , discussion 385–386
- 27 Thourani VH, Myung R, Kilgo P , et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg 2008; 86 (5) 1458-1464 , discussion 1464–1465
- 28 van Domburg RT, Meeter K, van Berkel DF, Veldkamp RF, van Herwerden LA, Bogers AJ. Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 2000; 36 (3) 878-883
- 29 Møller A, Villebro N. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev 2005; (3) CD002294
- 30 Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359 (9301) 114-117