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[Myocardial revascularization combined with concomitant valve operations: report of 45 cases]
Chang-qing Gao1, Bo-jun Li, Cang-song Xiao
1Department of Cardiovascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Insights
Coronary artery bypass grafting (CABG) combined with valve surgery is a safe and effective procedure. This study shows good outcomes with improved cardiac function and no in-hospital mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Minimally Invasive Cardiac Surgery
Context:
- Coronary artery disease and valvular heart disease often coexist.
- Surgical intervention for both conditions requires careful planning and execution.
- Combined procedures aim to address multiple cardiac issues simultaneously.
Purpose:
- To present the surgical experience and outcomes of combined coronary artery bypass grafting (CABG) and valve operations.
- To evaluate the safety and efficacy of performing myocardial revascularization concurrently with valve surgery.
- To assess the impact of combined procedures on patient cardiac function and survival.
Summary:
- Forty-five patients underwent combined CABG and valve surgery between 1998 and 2002.
- The surgical technique involved sequential grafting of the saphenous vein and left internal mammary artery, followed by valve replacement or plasty.
- Patients experienced improved cardiac function (NYHA Class I-II) post-operation with no in-hospital mortality and no deaths during follow-up.
Impact:
- Combined CABG and valve surgery can be performed safely with favorable short-term and long-term results.
- The procedure leads to significant improvement in cardiac function for patients with combined coronary and valve disease.
- This approach offers a viable option for managing complex cardiac conditions, potentially reducing the need for multiple surgical interventions.
Objective:
To introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation.
Methods:
From 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class II (NYHA) in 7 patients, Class III in 30, Class IV in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomosis of the saphenous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min.
Results:
No mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class I-II and no patient died during follow-up.
Conclusions:
CABG combined with valve surgery can be safely performed with good results.