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Myocardial revascularization with combined aortic and mitral valve replacements
Insights
Myocardial revascularization with combined aortic and mitral valve replacement has acceptable early mortality but significant late mortality. Early deaths were linked to severe mitral regurgitation and low ejection fraction.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Adult Congenital Heart Disease
Background:
- The risks associated with combined aortic and mitral valve replacement and myocardial revascularization are not well-defined.
- Previous studies have documented outcomes for single valve replacement alongside coronary artery bypass grafting.
Purpose of the Study:
- To evaluate the outcomes of myocardial revascularization combined with aortic and mitral valve replacement.
- To identify risk factors associated with early and late mortality in this patient cohort.
Main Methods:
- A consecutive series of 33 patients undergoing combined myocardial revascularization and aortic/mitral valve replacement were analyzed.
- Operations were performed using hypothermic crystalloid potassium cardioplegia.
- Data on patient demographics, preoperative conditions, operative details, and outcomes were collected.
Main Results:
- The in-hospital mortality rate was 12.1% (4/33 patients).
- No perioperative myocardial infarctions occurred.
- The 72-month actuarial survival rate was 60.7%, with 27.6% of hospital survivors dying during follow-up.
- Early mortality was significantly associated with severe mitral regurgitation, low ejection fraction, high New York Heart Association classification, and extensive coronary artery disease.
Conclusions:
- Myocardial revascularization with combined aortic and mitral valve replacement can be performed with an acceptable early mortality rate.
- However, this procedure is associated with an appreciable late mortality rate.
- Preoperative factors like severe mitral regurgitation and low ejection fraction are significant predictors of early death.
Abstract:
Although the results of coronary artery bypass grafting plus single aortic or mitral valve replacement have been documented, the risk of myocardial revascularization with combined aortic and mitral valve replacement is not well defined. We present a series of 33 consecutive patients undergoing myocardial revascularization with combined aortic and mitral valve replacement during a period of almost seven years. There were 21 men and 12 women with a mean age of 67 years. All patients had congestive heart failure, and 21 (64%) had angina pectoris. Mean New York Heart Association functional classification was 3.4; eight patients (24%) had ejection fractions less than 0.40, and 13 patients (41%) had cardiac indices less than 2.0 L/min/m2. All operations were performed with hypothermic crystalloid potassium cardioplegia. The number of coronary arteries grafted varied from one to four (mean, 1.7 grafts per patient). Four patients died while in the hospital (12.1%). There were no perioperative myocardial infarctions. At a follow-up of 2 to 80 months (mean 40.7 months), death had occurred in eight (27.6%) of the 29 hospital survivors. Actuarial survival rate at 72 months was 60.7%. Although no preoperative factors predicted late death, early deaths were related significantly to severe mitral regurgitation, low ejection fraction, high New York Heart Association classification and extensive coronary artery disease (p less than 0.05). Myocardial revascularization with combined aortic and mitral valve replacement can be performed with an acceptable early mortality rate but with an appreciable late mortality rate.