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Combined valve replacement and myocardial revascularization
Insights
Combining valve replacement with coronary artery bypass grafting (CABG) is controversial. This study found that CABG with aortic valve replacement had lower mortality when cardioplegia was used, while mitral valve replacement with CABG had higher risks.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Surgery
- Coronary Artery Bypass Grafting
Background:
- The combination of valve replacement and coronary artery bypass grafting (CABG) for patients with significant concomitant disease is a subject of ongoing debate.
- Understanding the operative outcomes of these combined procedures is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the operative results and mortality rates of patients undergoing combined valve replacement and CABG.
- To compare outcomes based on the type of valve replaced (aortic, mitral, or both) and the use of cardioplegia.
Main Methods:
- A consecutive series of 201 patients undergoing combined valve replacement and CABG between July 1977 and June 1982 were retrospectively analyzed.
- Data collected included patient demographics, type of valve procedure, presence of coronary artery disease, use of cardioplegia, and operative outcomes (mortality).
Main Results:
- The operative mortality for aortic valve replacement and CABG was 8.5% overall, significantly lower when cardioplegia was used (4.9%) compared to when it was not (20%).
- The operative mortality for mitral valve replacement and CABG was higher at 21.9%, with specific challenges noted in patients with rheumatic disease or ischemic mitral regurgitation.
- Late survival rates for aortic valve replacement alone and combined with CABG were similar.
Conclusions:
- The use of cardioplegia significantly reduces operative mortality in patients undergoing aortic valve replacement and CABG.
- Mitral valve replacement combined with CABG carries a higher operative risk, particularly in specific patient subgroups.
- Combined valve and CABG procedures require careful patient selection and surgical technique to optimize outcomes.
Abstract:
Combining valve replacement with coronary artery bypass (CABG) for significant concomitant disease remains a controversial subject. To determine the operative results following combined valve replacement and CABG, we evaluated 201 patients seen consecutively between July 1977 and June 1982. CABG for vessels with greater than 70% stenosis was performed with aortic valve replacement in 106 patients, with mitral valve replacement in 82, and with aortic and mitral valve replacement in 13. There were 143 men and 58 women; the mean age was 67 years. Nine operative deaths (8.5%) occurred with aortic valve replacement and CABG: 5 of 25 (20%) when cardioplegia was not used and 4 of 81 (4.9%) with cardioplegia (p less than 0.01). The operative mortality rate for isolated aortic valve replacement without coronary disease during the same period was 5.9% (10 of 168). The late actuarial survival rate is similar for aortic valve replacement alone or aortic valve replacement and CABG. There were no operative deaths among patients having undergone aortic and mitral valve replacement and CABG; the rate was 15% (9 of 60) in patients having undergone aortic and mitral replacement and CABG. The operative mortality rate was 21.9% for mitral valve replacement and CABG (18 of 82). Rheumatic disease was present in 14 of these patients, two of whom had early deaths (14.3%), both after repeat mitral operations; 11 mitral valve replacements and CABG were done for degenerative mitral regurgitation with no deaths, and the remaining 57 patients had ischemic mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)