Related Experiment Videos
Coronary artery bypass grafting in the presence of valvular disease
R B Karp1, N Mills, L H Edmunds
1Department of Surgery, University of Chicago, Illinois.
Insights
Combining valve surgery with coronary artery bypass grafting (CABG) increases operative risk, especially for mitral valve disease. Complete revascularization remains superior for patients with valvular and coronary artery disease (CAD).
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Combined valvular and coronary artery disease (CAD) necessitates complex surgical decisions.
- Isolated valve surgery or coronary artery bypass grafting (CABG) carries different risk profiles than combined procedures.
Purpose of the Study:
- To compare the operative risks of combined valve surgery and CABG versus isolated procedures.
- To identify factors influencing mortality in patients undergoing combined cardiac surgeries.
Main Methods:
- Comparative analysis of operative mortality rates for combined versus isolated valve replacement/repair and CABG.
- Stratification of risk based on valve type (aortic vs. mitral) and etiology of valve dysfunction.
Main Results:
- Combined aortic valve replacement and CABG shows a slightly increased operative mortality (4-7%) compared to isolated aortic valve replacement.
- Combined mitral valve surgery and CABG has significantly higher operative mortality (7-20%) when mitral dysfunction is CAD-related.
- Increased risk factors for combined procedures include CAD-induced valve dysfunction, poor left ventricular function, NYHA Class IV, and emergency surgery.
Conclusions:
- Combined valve surgery and CABG generally increases operative risk compared to isolated procedures.
- Mitral valve surgery combined with CABG presents a higher risk, particularly when valve dysfunction is ischemic.
- Complete revascularization is crucial for patients with coexisting valvular and CAD.
Abstract:
Compared with isolated coronary artery bypass grafting (CABG), the combination of valve replacement or repair with coronary revascularization generally increases operative risk. However, complete revascularization is superior to no revascularization in patients with valvular and coronary artery disease (CAD). Patients who undergo aortic valve replacement and CABG have two unrelated disease processes; these patients only infrequently have ischemic cardiomyopathy, and the operative mortality is slightly increased to 4-7% for the combined procedure versus isolated aortic valve replacement. Patients who are operated on for mitral valve disease and CAD fall into two groups: 1) where CAD and mitral valve disease are not etiologically related, and 2) where mitral valve dysfunction is the result of ischemic changes. In the latter group, operative mortality significantly exceeds that for isolated mitral valve surgery, and surgical priority increases that difference (operative mortality 7-20%). Thus, the operative risk for a mitral valve procedure plus CABG exceeds that for isolated coronary revascularization or isolated valve replacement. In the combined procedure, risk increases if valve dysfunction is caused by CAD, if severe left ventricular function is present, if the patient has been assigned to Class IV, or if emergency operation is required.