Related Experiment Video

Updated: Aug 23, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
08:12

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Published on: May 26, 2023

Risk of combined coronary artery bypass and mitral valve replacement

S S Kabbani1, T T Bashour, E S Hanna

  • 1Western Heart Institute, St. Mary's Hospital and Medical Center, and the University of California, San Francisco, California 94117, USA.

Texas Heart Institute Journal
|December 1, 1984
PubMed

Insights

Combined coronary artery bypass and mitral valve replacement carries high risks, especially for patients with extensive coronary artery disease and left ventricular dysfunction. Caution is advised due to factors like ischemia and advanced heart failure impacting outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Medicine

Background:

  • Combined coronary artery bypass (CAB) and mitral valve replacement (MVR) is a complex procedure.
  • Assessing risk factors for combined CAB and MVR is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate operative mortality and identify risk factors in patients undergoing combined CAB and MVR.
  • To compare outcomes among patient subgroups based on preoperative variables.

Main Methods:

  • Retrospective analysis of 42 patients (26 men, 16 women, aged 53-80) undergoing combined CAB and MVR.
  • Preoperative cardiac catheterization to assess hemodynamic and surgical variables.
  • Evaluation of operative mortality and comparison across subgroups.

Main Results:

  • Eight patients (19%) died during the study period.
  • Adverse factors influencing mortality included ischemic instability, advanced New York Heart Association class, severe mitral/aortic regurgitation, extensive coronary artery disease, left ventricular dysfunction (elevated LVEDP, low EF), and high pulmonary vascular resistance.
  • Prolonged operative time was also a significant risk factor.
  • Mitral valve pathology type did not influence mortality.

Conclusions:

  • Combined CAB and MVR is associated with high risk, particularly in patients with extensive coronary artery disease and advanced left ventricular dysfunction.
  • Caution is recommended when considering this combined procedure for high-risk patients.
  • Further evaluation of pre- and postoperative afterload reduction and circulatory assist devices may be beneficial.

More Related Videos

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)13:10

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Published on: April 24, 2017

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair08:31

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

Related Concept Videos

Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Valve Prolapse I: Introduction01:27

Mitral Valve Prolapse I: Introduction

IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...