Related Experiment Videos
Determinants of operative survival following combined mitral valve replacement and coronary revascularization
Insights
The combined mitral valve replacement and coronary artery bypass graft operation had an 18% operative mortality. Emergency operations significantly increased mortality risk compared to elective procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Outcomes
Background:
- The combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) operation is a complex procedure for patients with severe valvular and coronary heart disease.
- Assessing operative survival rates is crucial for understanding the risks and benefits of this combined surgical approach.
Purpose of the Study:
- To determine the operative survival rate following combined MVR and CABG.
- To identify preoperative factors associated with operative mortality in patients undergoing combined MVR and CABG.
Main Methods:
- A retrospective evaluation of 100 consecutive patients undergoing combined MVR and CABG between 1972 and 1982.
- Analysis of operative mortality rates, comparing emergency versus elective procedures.
- Identification of preoperative clinical and hemodynamic factors correlating with operative death.
Main Results:
- The overall operative mortality rate was 18% (18 of 100 patients).
- Emergency operations had a significantly higher mortality rate (60%) compared to elective operations (10.5%; p < 0.01).
- Preoperative factors associated with operative death included advanced New York Heart Association (NYHA) functional class, elevated pulmonary vascular resistance, low cardiac index, and reduced ejection fraction.
Conclusions:
- The combined MVR and CABG operation carries a substantial operative risk, particularly in emergency settings.
- Preoperative patient status, including functional class and hemodynamic parameters, significantly influences operative outcomes.
- Myocardial protection strategies and complete revascularization improved outcomes in elective cases but not in emergency cases.
Abstract:
To determine the operative survival rate following combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) operation, we evaluated 100 patients, who were seen consecutively at the Peter Bent Brigham and Brigham and Women's Hospital from 1972 to 1982. There were 63 men and 37 women; the mean age was 62 years. Thirty-six patients were in New York Heart Association (NYHA) Functional Class III, and 64 were in functional Class IV. Mitral regurgitation was predominant in 76 patients; mitral stenosis, in 24. Emergency operations were performed in 15 patients, and elective or semielective operations were performed in 85. There were 18 operative deaths (18%): 9 in patients having elective operations (10.5%) and 9 in those having emergency operations (60%; p less than 0.01). Significant preoperative factors related to operative death were NYHA functional class, increased pulmonary vascular resistance, lower cardiac index, and lower ejection fraction in the nonsurvivors. The rate of survival did not differ according to sex, age, or degree of coronary artery disease. In addition, myocardial protection with potassium cardioplegia and complete coronary revascularization significantly reduced operative mortality in the elective group of patients but did not alter the mortality in the emergency group.