[Surgical therapy of the patient with valvular lesion combined with coronary disease]
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This study on valvular heart disease and coronary artery disease found combined surgical procedures improved patient symptoms and exercise capacity. Maintaining low heart temperature during cardioplegia was crucial for successful outcomes in these complex cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Coronary Artery Disease
Context:
- Patients with valvular lesions often have coexisting coronary artery disease.
- Surgical intervention for combined conditions presents unique challenges.
- Optimal timing and technique for combined procedures are critical.
Purpose:
- To evaluate the operative indications, challenges, and results of combined valvular and coronary artery surgery.
- To determine the effectiveness of specific surgical approaches like Aortocoronary Bypass Graft (ACBG) and Off-Pump Total Coronary Artery (OTCA) surgery.
- To assess the impact of intraoperative myocardial protection strategies, such as cardioplegia and hypothermia.
Summary:
- A study of 650 patients identified 51 with combined valvular and coronary disease requiring surgical intervention.
- Aortocoronary Bypass Graft (ACBG) was indicated for proximal stenosis >70%, while Off-Pump Total Coronary Artery (OTCA) was used for mild localized stenosis.
- Maintaining heart temperature below 15°C during cardioplegia was emphasized.
- Combined operations resulted in no early deaths and one late death at 3 years.
- Postoperative outcomes showed significant improvement in chest pain, clinical symptoms, and exercise capacity, with notable shifts in NYHA functional class.
Impact:
- Combined surgical approaches for valvular and coronary disease can lead to significant clinical improvement and enhanced exercise tolerance.
- The study highlights the importance of tailored surgical indications based on stenosis severity and location.
- Effective myocardial protection strategies are vital for minimizing mortality in complex cardiac surgeries.
Abstract:
We studied on operative indication, operative problem, and operative result in patients with valvular lesion with coronary disease. In 650 cases, 51 cases combined with coronary stenosis and ACBG (9 cases) or OTCA (6 cases) were performed in 15 cases of them. For operative indication, ACBG was applied in case with proximal stenosis of more than 70% and OTCA was applied in case with mild localized stenosis. Cardioplegia during operation was important and heart temperature should be kept less than 15 degrees C. In those cases with combined operation, there were no early deaths but one late death (3 years after operation). After operation, chest pain disappeared and clinical symptom and ability for exercise were improved. According to NYHA classification, the improvement before and after operation were class I, none and 11 cases; class II, one case and three cases; class III, 12 cases and none and class IV, two cases and none.