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Combined mitral valve and coronary artery surgery
Insights
Combined coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) surgery showed improved outcomes over time. Early mortality decreased significantly, with most patients experiencing functional improvement post-operation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair and Replacement
- Surgical Outcomes Research
Background:
- Combined coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) is a complex procedure with historically variable outcomes.
- Understanding factors influencing early and long-term survival is crucial for patient selection and procedural refinement.
Purpose of the Study:
- To evaluate the early and long-term outcomes of patients undergoing combined CABG and MVR.
- To identify adverse factors affecting survival and functional status.
- To assess the impact of surgical and postoperative management improvements on outcomes.
Main Methods:
- Retrospective analysis of 50 patients undergoing combined CABG and MVR over 10 years, with six cases including aortic valve replacement (AVR).
- Data collection included operative mortality, long-term survival, functional class, and identification of risk factors.
- Comparison of outcomes between the first and second halves of the study period to assess temporal trends.
Main Results:
- Overall early mortality was 8%, significantly decreasing from 36% (4/11) in the first half to 0% (0/39) in the second half.
- Patients with CABG + MVR + AVR (n=6) all survived the operation.
- Adverse factors for survival included advanced functional impairment, female sex, untreated aortic valvulopathy, and elevated pulmonary vascular resistance.
- Long-term follow-up (mean 31 months) of 46 survivors showed a 5-year survival rate of 40%.
- Most patients (46/46) improved by at least one functional class.
Conclusions:
- Combined CABG and MVR demonstrated significantly improved early outcomes in the latter half of the study period, likely due to surgical advancements like cold potassium cardioplegia.
- Postoperative management, including intra-aortic balloon pumping, also contributed to better results.
- Despite challenges, the procedure offers significant functional improvement for survivors, though long-term survival rates warrant continued attention.
Abstract:
During the past 10 years, 50 patients underwent combined coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) at our clinic, with additional aortic valve replacement (AVR) in six cases. The early mortality was 8%. During the first half of the study period this mortality was 4/11 patients, but in the second half it was 0/39. All six patients with CABG + MVR + AVR survived the operation. Adverse factors were found to be advanced functional impairment, female sex, concomitant untreated aortic valvulopathy and elevated pulmonary vascular resistance. All 46 patients who survived the operation were followed up for a mean period of 31 months, and during that time there were nine deaths. The survival rate was 54% after 3 years and 40% after 5 years. Most of the patients had improved by at least one functional class. The good results in this series probably were attributable to improvements in surgical procedure (introduction of cold potassium cardioplegia) and in postoperative management (intra-aortic balloon pumping).