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[Management strategy for patients with coronary artery disease associated with valve disease]
Y Okamura1, Y Mochizuki, H Iida
1Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
Insights
Combined coronary artery bypass (CAB) and valve surgery yielded acceptable results. Patients with mild-moderate valve disease may benefit from simultaneous valve intervention during CAB.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Surgery
- Coronary Artery Bypass Grafting
Context:
- The combined operation of coronary artery bypass (CAB) and valve surgery is a topic of ongoing debate.
- This study reviews outcomes for patients undergoing combined CAB and valve procedures.
Purpose:
- To evaluate the safety and efficacy of combined coronary artery bypass and valve surgery.
- To determine the outcomes of reoperative valve replacement after prior CAB.
Summary:
- Between 1992 and 2000, 13 patients had combined CAB and valve replacement, and 4 had reoperative valve replacement after prior CAB.
- While two patients died post-operatively due to complications (sepsis, unrelated causes), the majority experienced excellent outcomes.
- Reasons for reoperation included missed aortic stenosis, and progression of aortic or mitral valve disease.
Impact:
- The findings suggest that combined CAB and valve replacement is an acceptable procedure.
- Consideration for valve surgery during CAB is recommended for patients with mild-moderate valve disease.
Background:
The indication of combined operation of coronary artery bypass (CAB) and valve surgery is controversial.
Methods:
Between April 1992 and January 2000, 13 patients underwent a combined operation with CAB and valve replacement, and 4 patients (2 were overlapped) who had had a previous CAB underwent a reoperative valve replacement.
Results:
One patient who underwent AVR and reCAB 11 years after the initial CAB died. Another patient with preoperative MRSA pneumonia and received MVR and CAB died 4 months after surgery with MRSA sepsis. However, others showed an excellent post-operative course. The causes of necessitating the reoperation were: unawareness of aortic stenosis at the initial emergency CAB in 1 patient, progression of aortic stenosis in 1 patient, progression of aortic regurgitation in 1 patient, and progression of mitral regurgitation in 1 patient.
Conclusion:
The results of the combined CAB and valve replacement operation were acceptable. Patients with mild-moderate valve disease should be considered as candidates for valve surgery at the time of CAB.