[Valvular surgical treatment concurrent with myocardial revascularization]
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P de L Lavítola1, L A Dallan, F Tarasoutchi
1Instituto do Coração, Hospital das Clínicas, FMUSP.
Insights
Combined valve surgery and myocardial revascularization showed similar mortality to isolated procedures. Clinical improvement supports continuing these associated surgical treatments for better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Context:
- Myocardial revascularization (coronary artery bypass grafting) is often performed with valve surgery.
- Coronary insufficiency is common in patients undergoing aortic or mitral valve surgery.
Purpose:
- To evaluate morbidity and mortality associated with combined valve surgery and myocardial revascularization.
- To compare outcomes of combined procedures with isolated valve surgery.
Summary:
- A study of 103 patients undergoing combined valve and myocardial revascularization revealed immediate postoperative mortality of 10.6% and late mortality of 3.89%.
- Complications included low cardiac output, arrhythmias, mediastinitis, infarction, hemorrhage, graft occlusion, and sepsis.
- Late follow-up showed functional capacity improvements in most patients, with few requiring repeat revascularization.
Impact:
- Combined valve and myocardial revascularization procedures demonstrate acceptable mortality rates.
- Clinical improvement in patients undergoing these combined procedures supports their continued use.
- This approach offers a viable option for patients with combined valve and coronary artery disease.
Purpose:
To study the morbidity and mortality due to valvar surgical treatment performed concomitantly to myocardial revascularization.
Methods:
From 1650 patients submitted to mitral or aortic valve surgical treatment, 103 (6.24%) had it associated to myocardial revascularization. Coronary insufficiency was associated to aortic valvar lesion in 66 (64.0%) patients, group I, with mean age of 62.3 +/- 8 years; and in 37 (35.9%) patients with mitral valve lesion, group II, with mean age of 57.8 +/- 5.8 years. Diagnosis was based upon the anamnesis, physical examination and confirmed by cine-coronarographic findings.
Results:
I-Complications at the immediate postoperative; a) mortality 11 (10.6%) patients, 6 (9.09%) from group I: by low cardiac output 3, uncontrolled arrhythmia 1, mediastinitis 1; acute infarction with cardiogenic shock 1, and 5 (134.5%) of group II: uncontrolled hemorrhage 2, sudden death 1, saphenous vein graft occlusion, respiratory insufficiency and sepsis 2; b) controlled intercurrences that increased the time of hospitalization: mental disorder 5 patients; CVA 7, diabetes decompensation 2, worsening of chronic renal insufficiency 1, upper level digestive hemorrhage 1 and respiratory insufficiency 3 patients. II-late postoperative complications of 77 (83.6%) patients which could be followed up during a period of 60 months: 1) mortality: 3 (3.89%) patients; 2 due to cardiomyopathy and 1 by acute myocardial infarction; 2) late evolution-functional capacity III (NYHA) by cardiomyopathy 6; I/II 68 patients; mild angina 6 patients, 2 underwent revascularization at the end of final 36-42 months.
Conclusion:
The clinical improvement and mortality indexes statistically similar to the isolate surgical acts stimulate us to keep up with such associate procedures.