Related Experiment Videos
Combined coronary bypass grafting and mitral valve surgery: Early and late results
G Ruvolo1, G Speziale, R Bianchini
1Institute of Cardiac Surgery, University La Sapienza, Rome, Italy.
Insights
Combined mitral valve replacement and coronary artery bypass grafting have high mortality. Preoperative left ventricular function significantly impacts both hospital and long-term survival in these cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Combined mitral valve replacement (MVR) and coronary artery bypass grafting (CABG) procedures carry a higher mortality risk than isolated operations.
- Understanding predictors of mortality is crucial for improving outcomes in complex cardiac surgery.
Purpose of the Study:
- To identify factors associated with hospital and late mortality after combined MVR and CABG.
- To evaluate the impact of preoperative patient characteristics and surgical variables on outcomes.
Main Methods:
- Retrospective analysis of 67 consecutive patients undergoing combined MVR and CABG.
- Assessment of preoperative data, including NYHA functional class, left-ventricular motion score, and aortic cross-clamp time.
- Follow-up to determine hospital mortality and late survival rates.
Main Results:
- Hospital mortality rate was 13.4%.
- Preoperative NYHA functional class, left-ventricular motion score, and aortic cross-clamp time were significantly associated with hospital mortality.
- Five-year survival was 76.1%, with global wall-motion score being the only significant predictor of late survival.
Conclusions:
- Preoperative left ventricular function is a strong predictor of both hospital and late mortality in patients undergoing combined MVR and CABG.
- While other factors like NYHA class and cross-clamp time influence hospital mortality, ventricular function is key for long-term survival.
Abstract:
It is reported that the mortality rate for combined coronary bypass grafting and mitral valve replacement is greater than for either isolated operation. To evaluate the effects of various predicting factors we analyzed the results of 67 consecutive patients undergoing combined mvr and CABG. The mean age was 61.3 +/- 7 years. There were 55 males and 12 females and the mean follow-up was 59.4 +/- 7 months. The hospital mortality rate was 13.4% (9/67). Preoperative NYHA functional class (p<0.05), left-ventricular motion score (increased scores indicating impaired function, (p<0.05), and aortic cross-clamp time (p<0.05) were associated with hospital mortality. There was no significant relationship of age (>60), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, or previous myocardial infarction with hospital mortality. There were 7 late deaths, and survival at five years was 76.1%. Although there was a trend for preoperative NYHA class and aortic cross-clamp time to be associated with late survival, the only factor significantly related to late survival was global wall-motion score (p<0.05). Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival, but we have found no such relationship. Our results indicate that both hospital and late mortality are strongly correlated with preoperative left ventricular function.