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[Valve replacement and aorto-coronary bypass]
Insights
Combined heart valve and coronary artery bypass graft surgery showed significant improvements in patients. However, early mortality was noted, particularly in aortic valve replacement cases, highlighting the need for careful patient selection and management of coronary lesions.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Coronary Artery Bypass Grafting
Context:
- The study examines combined surgical procedures for cardiac valves and coronary arteries.
- Data was collected from 27 consecutive patients between 1970 and 1976.
- This period saw advancements in cardiopulmonary bypass techniques and valve replacement procedures.
Purpose:
- To evaluate the outcomes of combined valve replacement and coronary artery bypass grafting.
- To identify risk factors and complications associated with this complex surgical approach.
- To refine indications for coronary arteriography in patients undergoing valve surgery.
Summary:
- The study involved 18 aortic valve replacements, 8 mitral valve replacements, and 1 double mitro-aortic replacement, with a longer cardiopulmonary bypass time compared to valve replacement alone.
- In-hospital mortality was 18.5%, concentrated in the aortic valve group and earlier cases, with post-mortem findings revealing unaddressed coronary lesions.
- Despite complications, 17 followed-up patients showed substantial improvement, with a mean follow-up of 24 months.
Impact:
- The findings underscore the importance of addressing both valvular and coronary lesions concurrently.
- The study suggests expanding indications for coronary arteriography to include most patients undergoing valve surgery, excluding specific age groups or those without atherosclerosis risk factors.
- Identifying unsuspected coronary lesions as a significant operative risk factor informs future surgical strategies.
Abstract:
Combined surgery on the valves and on the coronary arteries by bypass grafts has been carried out on 27 consecutive patients (1970 to 1976) and involved 18 aortic valve replacements, 8 mitral valve replacements, and one double mitro-aortic replacement; the mean duration of extra-corporeal circulation (145 mn) was significantly higher than that for valve replacements alone carried out during the same period (p less than 0.01). The five deaths occurring in hospital (18.5%) all occurred in the aortic valve group, and were amongst the first 15 cases operated on (1970 to 1974). The 4 post-mortem studies carried out showed similar findings, namely myocardial infarction and significant coronary lesions which had not been bypassed. Two secondary deaths due to infective complications occurred in the first six months. The 17 patients who were followed up after surgery and had a mean follow-up period of 24 months, were all substantially improved by comparison with their pre-operative state, despite certain complications affecting either the valves (1 requiring re-operation) or the coronary arteries (3 infarcts). The indications for coronary arteriography, which are related to the indications for surgery, are being enlarged so that they will include the majority of patients operated on excluding those of more than 65 to 70 years of age and also those aged less than 40 years who have no risk factors for atherosclerosis and no clinical or electrocardiographic signs suggesting a coronary lesion. A study of the operative risk factors has shown the importance of unsuspected coronary lesions, and would appear to indicate correction of all valvular and coronary lesions seen at the time of operation.