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Results of combined valvular and myocardial revascularization operations
Insights
Combined coronary artery bypass grafting (CABG) and valve surgery offers significant patient improvement despite increased risks. This approach is recommended for adult patients with valvular disease and significant coronary lesions.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Combined coronary artery bypass grafting (CABG) and valvular operations are complex procedures.
- Assessing the risks and benefits of combined procedures versus valve replacement alone is crucial.
Purpose of the Study:
- To compare outcomes of combined CABG and valve surgery with valve replacement alone.
- To identify factors influencing mortality and improvement in patients undergoing these procedures.
Main Methods:
- Retrospective analysis of 105 patients undergoing combined CABG and valvular operations (aortic, mitral, or double/triple valve).
- Comparison with a control group undergoing valve replacement only.
- Analysis of operative times, mortality, and perioperative myocardial infarction (MI).
Main Results:
- Combined procedures had increased bypass and cross-clamp times.
- Early mortality was higher in combined groups (3.0% AV, 3.5% MV, 9.1% DTV) compared to valve-only (1%).
- Higher perioperative MI rates in combined groups (5% vs. 2.9%). Higher mortality in women over 70 undergoing combined procedures.
Conclusions:
- Despite increased risks, combined CABG and valve surgery leads to significant improvement and angina relief in survivors.
- Recommended principles include coronary arteriography, bypass of significant coronary lesions, valvular restoration, and myocardial preservation.
- The benefits of combined approach outweigh the small increase in risk for selected patients.
Abstract:
A total of 105 patients underwent combined coronary artery and valvular operations. Sixty-six had combined coronary artery bypass grafting (CABG) and aortic valve replacement (AV), 28 had CABG and mitral valve operations (MV), and 11 patients had CABG and double or triple valve operations (DTV). An average of 3.0 bypasses was done, range one to seven. These patients were compared to a similar group of patients who underwent valve replacement(s) only, without CABG. Bypass time was increased for the combined groups, as was ischemic cross-clamp time. Early mortality was 3.0% AV, 3.5% MV, and 9.1% DTV in the combined groups and 1% in the valve only groups. The higher mortality for the combined groups was almost entirely due to the 23% mortality in women over 70 years of age. Perioperative myocardial infarction (MI) was higher in the combined groups (5% MI, 9% probable MI versus 2.9% MI, 4.1% probable MI). All survivors were in improved clinical condition and free of angina. Mortality and improvement were unrelated to perioperative infarction. The small increase in risk compared to the significant improvement from the combined approach has led to the following principles: coronary arteriography on all adult patients requiring valvular operations; bypass of all significant coronary lesions; restoration of valvular function and hemodynamics; and myocardial preservation with cold cardioplegia during a single period of cross clamping, topical cold, and systemic hypothermia.