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Mitral valve replacement combined with coronary artery operation: determinants of early and late results
G W He1, C F Hughes, B McCaughan
1Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
Insights
This study found that while advanced age and heart function impact hospital mortality after mitral valve replacement and coronary artery bypass grafting, the cause and severity of mitral valve disease do not. Preoperative heart function and postoperative care influence long-term survival.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Combined mitral valve replacement (MVR) and coronary artery bypass grafting (CABG) may have higher mortality than individual procedures.
- The influence of mitral valve disease etiology and regurgitation severity on outcomes needs further investigation.
Purpose of the Study:
- To investigate the correlation between mitral valve disease cause, regurgitation severity, and hospital mortality.
- To assess the relationship between these factors and long-term survival after combined MVR and CABG.
Main Methods:
- Analysis of 135 patients undergoing MVR and CABG between 1974 and 1989.
- Univariate and multivariate regression analysis of 15 preoperative and operative variables.
- Long-term follow-up of hospital survivors.
Main Results:
- Hospital mortality was 11.8%. Advanced age, New York Heart Association (NYHA) functional class, and wall motion score were independently associated with hospital mortality.
- Mitral valve disease cause and regurgitation severity were not significantly related to hospital mortality or long-term survival.
- Long-term survival rates at 1, 2, 5, and 10 years were 91.9%, 89.9%, 78%, and 49.9%, respectively. Preoperative NYHA class and postoperative catecholamine use predicted late survival.
Conclusions:
- Factors like age and NYHA class are critical for hospital survival in combined MVR and CABG.
- Long-term survival is influenced by preoperative NYHA class and postoperative care, not the underlying cause or severity of mitral valve disease.
Abstract:
Mitral valve replacement combined with coronary artery bypass grafting has been reported as being associated with a higher mortality than either mitral valve replacement or coronary artery bypass grafting alone. Cause of mitral valve disease and severity of mitral regurgitation have been reported as related to mortality. To study the correlation of the cause of mitral valve disease and severity of mitral regurgitation to hospital mortality and long-term survival, we analyzed the results of 135 patients undergoing mitral valve replacement and coronary artery bypass grafting between June 1974 and August 1989. The hospital mortality was 11.8% (16/135). Fifteen preoperative and operative variables were tested for correlation with hospital or late mortality using univariate tests and multivariate regression. Advanced age (greater than 60 years), New York Heart Association functional class, and wall motion score were independently associated with hospital mortality (p less than 0.05). The cause of mitral valve disease and severity of mitral regurgitation were not related to hospital mortality or long-term survival (p greater than 0.05). The follow-up rate was 96.6% for the hospital survivors (115/119). Mean follow-up was 52.6 +/- 4.1 months. There were 35 late deaths. Survival was 91.9%, 89.9%, 78%, and 49.9% at 1, 2, 5, and 10 postoperative years, respectively. Preoperative New York Heart Association functional class and use of catecholamines during the postoperative intensive care period were independently related to late survival (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)