Myocardial revascularization with combined aortic and mitral valve replacements

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.