[Results of combined valvular and coronary surgery]

Between 1975 and 1984, 50 patients underwent cardiac valve replacement combined with coronary revascularization. All had heart failure (class II 28, class III 18, class IV 4), and only 39 complained of angina, including 12 who had previously experienced myocardial infarction; 32 aortic valves, 17 mitral valves and 1 mitral + 1 aortic valve were replaced, these operations being combined with 1 to 4 bypasses (mean: 1.3) per patient. The overall peri-operative mortality rate (i.e. before the 30th post-operative day) was 12 p. 100 (aortic valve 6.2 p. 100, mitral valve 23.5 p. 100), with a regular decrease since 1978. The overall incidence of peri-operative infarction was 6 p. 100 (2.4 p. 100 after 1978). After the peri-operative period 15 patients died, 8 of them of cardiac disease (6 of heart failure, 1 of myocardial infarction, 1 of embolic accident). All survivors were improved, with only 3 cases of heart failure and 1 case of residual angina during a mean follow-up period of 36.1 months (range: 6-120 months). In combined valvular and coronary surgery the mortality rate and the incidence of peri-operative infarction have gradually decreased as years went by, and they are now similar to those of valvular surgery alone. This decrease is due to the progress achieved in cardiac surgery, notably to optimal myocardial protection and maximal revascularization. This progress, together with technical improvements in anaesthesia and intensive care, has rendered combined surgery feasible with an acceptable operative risk and with such satisfactory long-term results that patients over 70 years of age can now be offered this type of treatment.