Download PDF
Thorac Cardiovasc Surg 2014; 62(01): 052-059
DOI: 10.1055/s-0033-1357083
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Impact of Smoking Status on Outcomes after Concomitant Aortic Valve Replacement and Coronary Artery Bypass Graft Surgery

Akshat Saxena
1   Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
,
Leonard Shan
2   Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
,
Diem T. Dinh
3   Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
,
Christopher M. Reid
3   Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
,
Julian A. Smith
4   Department of Surgery (MMC), Monash University and Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia
,
Gilbert C. Shardey
5   Cabrini Medical Centre, Malvern, Victoria, Australia
,
Andrew E. Newcomb
2   Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
6   Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Victoria, Australia
› Author Affiliations
Further Information

Publication History

15 April 2013

07 August 2013

Publication Date:
25 October 2013 (online)

    Permissions and Reprints All articles of this category

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.

Keywords

smoking - cardiac surgery - coronary artery bypass graft - CABG - aortic valve replacement - AVR - morbidity - survival
 

  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Gulbins H, Malkoc A, Ennker J. Combined cardiac surgical procedures in octogenarians: operative outcome. Clin Res Cardiol 2008; 97 (3) 176-180
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Christenson JT, Aeberhard JM, Badel P , et al. Adult respiratory distress syndrome after cardiac surgery. Cardiovasc Surg 1996; 4 (1) 15-21
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Turan A, Mascha EJ, Roberman D , et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114 (4) 837-846
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 22 Klein LW, Nathan S. Coronary artery disease in young adults. J Am Coll Cardiol 2003; 41 (4) 529-531
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Møller A, Villebro N. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev 2005; (3) CD002294
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar