Combined procedure of coronary artery bypass grafting and valve repair

The safety of combined operative procedures for valvular and coronary artery disease was reviewed in 27 patients. Twelve patients had aortic valve disease and 15 had mitral valve disease. Forty-seven coronary artery reconstructions were performed, and average of 1.7 per patient. Twenty-two patients underwent valve replacement and 5 had valvuloplasty. Congestive heart failure was the major symptom in 20 patients, and angina was the major symptom in 7. Eight of the patients with congestive heart failure had no angina, but significant coronary stenoses were demonstrated at routine coronary angiography. Coronary reconstruction was performed before valve repair. Two patients died postoperatively (a hospital mortality of 7.4%), and there were 4 late deaths from 2 to 28 months postoperatively. There were no postoperative myocardial infarctions. Contrary to previous reports, coronary artery reconstruction and valve repair need not be associated with an increased risk. Protection of the myocardium by coronary perfusion through reconstructed coronary arteries enables valve repair to be done without greater risk than valve repair alone. All patients considered for valve repair should have coronary angiography.