Combination of mitral and coronary artery surgery

Between 1977 and 1984, 63 patients had an aortocoronary bypass combined with mitral valve surgery. The age of patients varied from 36-72 years. Patients were assigned to 2 groups depending on the aetiology of the mitral valve disease. In group A (42 patients) the aetiology was rheumatic or congenital, in group B (21 patients) the mitral disease was secondary to ischaemic heart disease. In all but one patients the mitral valve was replaced by a prosthesis. A similar number of bypass grafts ranging from 1 to 5 was done in each group. Hospital mortality was 2.3% (1 patient) for A and 9.5% (2 patients) for B. Major causes of morbidity were low cardiac output (5% for A and 4.8% for B), myocardial infarction (4.8% for B) as well as multiple organs failure (4.8% for B). Follow-up averaged 2.7 +/- 2.0 years (0.4-7 years). Linearized (%/patients-years) mortality was 2.6 and 4.9 for A and B, respectively. Thromboembolism occurred at a rate of 2.6 for A and 4.8 for B; myocardial infarction at a rate of 1.3 for A and 0 for B. Functional improvement was similar for the two groups (1.3 +/- 0.7 classes for A and 1.6 +/- 0.6 for B). Four-year actuarial survival was 0.93 and 0.73 for A and B, respectively. Although no significant difference could be found between groups A and B, it seems that attrition rate is somewhat more favourable for group A than B. The small increase in risk compared to the significant improvement supports the policy of the combined approach of mitral valve and ACBG surgery.(ABSTRACT TRUNCATED AT 250 WORDS)