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Results of combined valve replacement and myocardial revascularization. Relation to method of myocardial protection
T K Kaul1, R al Khadimi, H Sharif
1Regional Adult Cardiothoracic Unit, Broadgreen Hospital, Liverpool, U.K.
Insights
Cold blood cardioplegia significantly improved patient survival and quality of life in patients undergoing combined valve and coronary artery bypass surgery. This method reduced myocardial damage markers and late mortality compared to other techniques.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Surgical Outcomes
Background:
- Combined valve and coronary artery bypass surgery is a complex procedure.
- Myocardial protection strategies are crucial for patient outcomes.
- Different cardioplegic solutions have been employed historically.
Purpose of the Study:
- To compare the efficacy of three myocardial protection methods during combined valve and coronary artery bypass surgery.
- To evaluate the impact of different cardioplegia techniques on early and late outcomes.
- To assess myocardial protection by analyzing enzyme release and long-term survival.
Main Methods:
- Retrospective analysis of 123 patients undergoing combined valve and coronary artery bypass surgery (1974-1985).
- Patients were divided into three groups based on myocardial protection: ischaemic cardiac arrest (Group I), cold crystalloid cardiopleia (Group II), and cold blood cardiopleia (Group III).
- Outcomes assessed included early mortality, enzyme release (LDH, AST), angina recurrence, late mortality, patient survival, and quality of life.
Main Results:
- Early mortality rates were similar across groups (19%, 17.6%, 11.7%; NS).
- Cold blood cardioplegia (Group III) showed significantly lower release of LDH and AST compared to cold crystalloid cardiopleia (Group II).
- Group III demonstrated superior long-term outcomes with reduced angina recurrence (0.07% per patient year) and late mortality (2.6% per 100 years) compared to Groups I and II.
Conclusions:
- Cold blood cardioplegia offers superior myocardial protection during combined valve and coronary artery bypass surgery.
- The introduction of cold blood cardioplegic protection led to improved patient survival and quality of life.
- This technique is associated with better long-term clinical outcomes and reduced myocardial injury markers.
Abstract:
One hundred and twenty-three patients underwent combined valve and coronary artery bypass surgery, between 1974 and 1985. Seventy patients had aortic valve replacement, 53 had mitral valve replacement; 63.4% were male and 45% were over 60 years (mean 59 +/- 2 years). Ischaemic cardiac arrest was used in 21 patients (Group I), cold crystalloid cardioplegia in 51 (Group II), and cold blood cardioplegia in 51 (Group III). Group III had a greater number of patients with poor preoperative functional status and left ventricular function. Early mortality was 19%, 17.6% and 11.7% in Groups I, II and III respectively (NS), and was not influenced by patients age, number of vessels with critical coronary artery disease and the type of the valve procedure. There was a significant decrease in the release of LDH and AST in Group III when compared with Group II (p less than 0.02 and p less than 0.01) respectively. The linearized rate of recurrence of angina (% per patient year) was 0.4, 0.95 and 0.07; and late mortality (% per 100 years) was 5.8, 3.2 and 2.6 in Groups I, II and III respectively. Patient survival and the quality of life has been improved since the introduction of cold blood cardioplegic protection.