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Risk factors for mortality after primary combined valvular and coronary artery surgery

J K Kirklin1, D C Naftel, E H Blackstone

  • 1Department of Surgery, University of Alabama, Birmingham Medical Center.

Circulation
|June 1, 1989
PubMed

Insights

Identifying risk factors for death after combined valve and coronary artery bypass graft surgery (CABG) is crucial. Older age, instability, and specific valve/artery conditions increase mortality risk in CABG patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Valvular Heart Disease
  • Coronary Artery Disease

Background:

  • Combined valvular and coronary artery bypass graft surgery (CABG) presents unique challenges.
  • Understanding risk factors for mortality is essential for patient stratification and improved outcomes.
  • Previous analyses may have used arbitrary stratifications, limiting comparative accuracy.

Purpose of the Study:

  • To examine risk factors for death in patients undergoing combined mitral valve (MV) or aortic valve (AV) surgery and CABG.
  • To identify patient subsets with favorable or unfavorable prognoses.
  • To advocate for multivariate analysis in comparing surgical outcomes.

Main Methods:

  • Retrospective analysis of 141 patients undergoing isolated MV or AV surgery with concurrent CABG (1986-1988).
  • Actuarial survival analysis was performed.
  • Risk factors for mortality were identified and analyzed, including age, hemodynamic status, and specific cardiac conditions.

Main Results:

  • Overall 1-month survival was 92%, and 1-year survival was 79%.
  • Mortality risk was highest immediately post-operation, declining over approximately 4 months.
  • Significant risk factors for death included older age, preoperative hemodynamic instability, left main coronary artery disease, ischemic mitral valve disease, tricuspid incompetence, and longer ischemic times.
  • Elderly patients (≥70 years) with hemodynamic instability had a 30-day mortality of 20%.
  • A favorable risk group (under 70, no left main stenosis, hemodynamic stability, no ischemic MV disease) had <5% 30-day mortality.

Conclusions:

  • Older age, hemodynamic instability, left main coronary artery disease, ischemic mitral valve disease, tricuspid incompetence, and prolonged ischemic time are significant risk factors for mortality after combined valve and CABG.
  • The elderly and hemodynamically unstable patients represent a high-risk subgroup.
  • Multivariate analysis using continuous variables is recommended for accurate comparison of surgical outcomes in different patient subsets.

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