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Influence of concomitant CABG and urgent/emergent status on mitral valve replacement surgery

V H Thourani1, W S Weintraub, J M Craver

  • 1Carlyle Fraser Heart Center, Department of Surgery, Emory Center of Outcomes Research, Atlanta, Georgia, USA.

The Annals of Thoracic Surgery
|October 4, 2000
PubMed

Insights

Adding coronary artery bypass grafting (CABG) to mitral valve replacement (MVR) increases risks and costs. Urgent or emergent MVR also elevates mortality and resource use, necessitating careful patient selection.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Health Economics

Background:

  • Mitral valve replacement (MVR) is a common cardiac procedure.
  • Concomitant coronary artery bypass grafting (CABG) is sometimes performed with MVR.
  • Understanding the impact of CABG on MVR outcomes is crucial.

Purpose of the Study:

  • To compare outcomes and resource utilization in patients undergoing MVR with and without CABG.
  • To analyze the influence of elective versus urgent/emergent status on MVR outcomes.
  • To identify factors affecting long-term mortality after MVR.

Main Methods:

  • Retrospective review of 1,844 patients undergoing primary MVR between 1980 and 1997.
  • Patients were categorized into four groups: elective MVR with/without CABG and urgent/emergent MVR with/without CABG.
  • Data collected included length of stay, in-hospital mortality, long-term survival, and hospital costs.

Main Results:

  • MVR with CABG showed significantly higher in-hospital mortality (elective: 14%, urgent/emergent: 41%) compared to MVR alone (elective: 6%, urgent/emergent: 20%).
  • Long-term survival rates were lower for patients undergoing MVR with CABG (elective: 32%, urgent/emergent: 28%) versus MVR alone (elective: 51%, urgent/emergent: 46%).
  • Hospital costs were significantly higher for elective MVR with CABG ($33,216) compared to MVR alone ($23,890).

Conclusions:

  • Concomitant CABG and urgent/emergent status significantly increase morbidity, mortality, and costs associated with MVR.
  • Careful evaluation of benefits versus resource utilization is essential for high-risk MVR patients.
  • The findings highlight the importance of patient selection for MVR procedures, especially when combined with CABG.
Abstract

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