Combined valvular and coronary artery surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Coronary Artery Disease

Background:

• Combined valvular and coronary artery operations address complex cardiac conditions.
• Patient demographics included a significant proportion with advanced New York Heart Association Functional Class IV and prior myocardial infarction.
• Coronary angiography revealed unexpected significant coronary artery disease in 14 patients.

Purpose of the Study:

• To evaluate the outcomes of combined valvular and coronary artery operations.
• To assess the safety and efficacy of a surgical strategy prioritizing coronary artery bypass grafting before valve replacement.
• To analyze operative and late mortality rates in patients undergoing this complex procedure.

Main Methods:

• A cohort of 45 patients underwent combined operations between 1971 and 1975.
• Procedures involved aortic, mitral, or tricuspid valve interventions alongside coronary artery bypass grafting.
• Grafts were performed before valve replacement, with continuous coronary perfusion to minimize ischemia.

Main Results:

• Aortic valve disease was the most common indication (30 patients), followed by mitral valve disease (13 patients).
• The average number of grafts per patient was 2.5.
• Operative mortality was 16%, with a late mortality of 8%. Two patients experienced perioperative myocardial infarction.

Conclusions:

• Combined valvular and coronary artery operations can be performed with acceptable mortality rates.
• The surgical technique of performing coronary artery bypass grafting before valve replacement, while maintaining perfusion, appears effective.
• Careful patient selection and surgical planning are crucial for managing patients with combined valve and coronary disease.