[Early and late results of combined valvular and coronary artery surgery]

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Valvular Heart Disease

Context:

• Combined valvular and coronary artery surgery addresses complex cardiac conditions.
• Preoperative assessment revealed significant cardiac dysfunction in 33% of patients.
• A notable percentage (24%) presented with advanced New York Heart Association (NYHA) functional class IV.

Purpose:

• To identify risk factors for cardiac-related events and late mortality in patients undergoing combined valvular and coronary artery surgery.
• To analyze the long-term outcomes of this complex surgical procedure.

Summary:

• The study included 42 patients with aortic (26) or mitral (16) valve disease undergoing combined surgery.
• No operative deaths occurred, with 96% early graft patency.
• Over a mean follow-up of 5.6 years, 8 late deaths were recorded, with 5- and 10-year survival rates of 86% and 64%, respectively.
• Cardiac dysfunction was a key predictor of late mortality.
• Cardiac-related events occurred in 9 patients, with 5- and 10-year freedom from events at 78% and 59%, respectively.
• Cardiac dysfunction and mitral valve surgery independently predicted cardiac events.
• Combined mitral and coronary artery surgery yielded unfavorable results in patients with pre-existing cardiac dysfunction.

Impact:

• Cardiac dysfunction is a critical factor influencing long-term survival and event-free survival after combined cardiac surgery.
• Mitral valve surgery, in conjunction with coronary artery bypass grafting, poses a higher risk for cardiac events in patients with impaired cardiac function.
• Findings highlight the need for careful patient selection and risk stratification for combined procedures.