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[Coronary disease in patients operated on for valvulopathy]
R Mariotti1, C Palagi, U Limbruno
1Istituto di Cardiologia, Università degli Studi, Pisa.
Insights
Coronary artery disease (CAD) impacts valvular heart disease surgery outcomes. Combined CAD and valvular surgery improves long-term prognosis despite higher early mortality, with rare post-operative CAD development.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Context:
- Valvular heart disease (VHD) frequently coexists with coronary artery disease (CAD).
- The management of patients with both VHD and CAD presents unique clinical challenges.
- Understanding the interplay between CAD and VHD is crucial for optimizing surgical outcomes.
Purpose:
- To evaluate the influence of significant coronary artery disease (CAD) in patients with valvular heart disease (VHD) or prosthetic valves.
- To analyze the impact of CAD on early and late results of surgical procedures for VHD.
- To assess the incidence and clinical significance of CAD in the context of VHD management.
Summary:
- The incidence of CAD in patients with VHD is approximately 11%.
- Combined surgical procedures for CAD and VHD lead to higher early mortality but significantly better long-term prognosis.
- Post-operative development of CAD after valvular surgery is rare, with few patients experiencing anginal symptoms or new CAD findings.
Impact:
- This study highlights the importance of addressing concomitant CAD in VHD patients undergoing surgery.
- Combined surgical strategies can improve long-term survival and quality of life for selected patients.
- The findings suggest that valvular surgery itself rarely leads to the development of new CAD.
Abstract:
In order to evaluate the influence of a significant coronary artery disease in patients with valvular heart disease or with prosthetic valves, we reviewed literature and our own experience. The incidence of coronary artery disease in valvulopathies has been diffusely studied and reported and, in a consecutive series of our hemodynamic studies, resulted 11%. The influence of a coronary artery disease on early and late results of a surgical procedure is different whether the coronary artery disease is operated or not. In particular, the combined surgery shows a higher early mortality, but a much better long-term prognosis. In addition, sometimes surgery introduces rare causes of coronary artery disease. Finally, it seems that coronary artery disease arises very rarely in patients undergone valvular surgery or, at least, patients rarely complain anginal symptoms in the post-surgical follow-up. In our experience on 529 patients only 6 complained typical angina and only 2 showed a coronary artery disease not present at the time of operation.