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Early results of mitral valve replacement
E Ståhle1, R Bergström, T Malm
1Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
Scandinavian Journal of Thoracic and Cardiovascular Surgery
|January 1, 1991
Summary
Mitral valve replacement (MVR) outcomes show higher early mortality with coronary artery bypass grafting (CABG). Factors like heart failure and previous surgery impact survival. Optimizing surgical technique and myocardial preservation is key.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Mitral valve replacement (MVR) is a critical procedure for severe mitral valve disease.
- Concomitant coronary artery bypass grafting (CABG) is often performed with MVR in patients with ischemic heart disease.
Purpose of the Study:
- To review early results of mitral valve replacement (MVR) in unselected patients.
- To compare outcomes of MVR alone versus MVR with concomitant coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective review of 336 patients undergoing MVR.
- Patients were divided into MVR-only (n=261) and MVR + CABG (n=75) groups.
- Multivariate analysis was used to identify factors related to early mortality and myocardial injury.
Main Results:
- Early mortality (less than 30 days) was 7% for MVR and 16% for MVR + CABG.
- Congestive heart failure, diabetes, and prior cardiac surgery were associated with mortality in the MVR group.
- Peroperative technical complications occurred in 32% of MVR and 17% of MVR + CABG cases.
- Myocardial injury incidence was 21% in MVR and 35% in MVR + CABG, with associated mortality of 19% and 23%, respectively.
Conclusions:
- Early mortality after MVR is significantly higher when combined with CABG.
- Factors influencing mortality and myocardial injury include patient comorbidities and operative details.
- Improving MVR outcomes requires timely intervention, optimal myocardial protection, and minimizing technical errors.