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[Early and late results of combined valvular and coronary artery operations]
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.
Insights
This study on ischemic heart disease patients undergoing valvular surgery found that combined procedures had higher early mortality than isolated valve surgery. Age over 65 and dialysis were key predictors of early death.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Ischemic Heart Disease Management
Background:
- Ischemic heart disease frequently necessitates surgical intervention, often involving coronary artery bypass grafting (CABG) alongside valve repair or replacement.
- The optimal surgical strategy for patients with ischemic heart disease requiring valvular intervention remains an area of active investigation.
Observation:
- A cohort of 122 patients with ischemic heart disease underwent various valvular surgical procedures, including combined CABG with aortic valve surgery (39 patients), mitral valve operations (72 patients), and double or triple valve operations (8 patients).
- Isolated mitral valve replacement was performed in only 3 patients with acute myocardial infarction-related ruptured papillary muscle.
- Early mortality rates varied: 5.1% for aortic valve (AV) procedures, 2.8% for mitral valve (MV) procedures, and 12.5% for double/triple valve (DTV) operations in combined groups, versus 0% in the valve-only group.
- Graft patency rates were high at 93.5%.
Findings:
- Univariate analysis identified patient age over 65 years and dialysis as significant predictors of early mortality.
- At a mean follow-up of 5.4 years, 5-year survival rates (all-cause death-free) were 57.9% for AV, 69.6% for MV, and 75.0% for DTV procedures.
- Five-year cardiac death-free rates were 73.8% for AV, 77.5% for MV, and 75.0% for DTV procedures.
Implications:
- Combined CABG and valvular surgery in ischemic heart disease patients carry specific early mortality risks, influenced by patient age and comorbidities like dialysis dependence.
- Long-term survival outcomes demonstrate considerable benefit from these complex procedures, though specific rates vary by valve operated.
- Risk factor identification aids in patient selection and perioperative management to improve outcomes in complex cardiac surgery.
Abstract:
A total of 122 patients with ischemic heart disease underwent valvular surgery. Thirty-nine had combined CABG and aortic valve surgery (included Bentall method), 72 had CABG and mitral valve operations, and 8 patients had CABG and double or triple valve operations. Only 3 patients for ruptured papillary muscle due to acute myocardial infarction had isolated mitral valve replacement. Early mortality was 5.1% AV, 2.8% MV and 12.5% DTV in the combined groups and 0% in the valve only group. The grafts patency rate was 93.5%. Univariate analysis of risk factors selected in the dialysis patients and the patients age older than 65 years as the strongest predictors for early death. At the mean follow up period of 5.4 +/- 4.8 year after surgery, the 5-year all death free rates were 57.9 +/- 9.6% AV, 69.6 +/- 5.8% MV and 75.0 +/- 15.3% DTV. The 5-year cardiac death free rates were 73.8 +/- 9.0% AV, 77.5 +/- 5.4% MD and 75.0 +/- 15.3% DTV.