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Early and late results following combined coronary bypass surgery and mitral valve replacement
S S Ashraf1, N Shaukat, N Odom
1Department of Cardiothoracic Surgery, Manchester Royal Infirmary, UK.
Insights
Left ventricular function significantly impacts mortality after combined mitral valve replacement and coronary artery bypass grafting. Impaired ventricular function and higher NYHA class are key risk factors for hospital mortality in these patients.
Area of Science:
- Cardiac Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Combined mitral valve replacement (MVR) and coronary artery bypass grafting (CABG) is a complex procedure.
- Identifying factors influencing mortality is crucial for patient management and surgical strategy.
- Previous studies have suggested various predictors for outcomes in combined MVR and CABG.
Purpose of the Study:
- To investigate the association between perioperative and operative variables and mortality in patients undergoing MVR and CABG.
- To identify predictors of both hospital and late mortality after this combined procedure.
Main Methods:
- Retrospective analysis of 66 consecutive patients undergoing combined MVR and CABG.
- Data collected included patient demographics, preoperative conditions, operative details, and follow-up outcomes.
- Statistical analysis was performed to determine significant relationships between variables and mortality.
Main Results:
- Hospital mortality rate was 7.6%. Significant predictors of hospital mortality included New York Heart Association (NYHA) functional class, left ventricular global wall motion score, and cross-clamp time.
- Late mortality occurred in eight patients, with survival rates at 1, 3, and 5 years being 92.4%, 83.2%, and 80.2%, respectively.
- Left ventricular global wall motion score was the only significant predictor of late survival (P = 0.001).
Conclusions:
- Left ventricular function is a strong determinant of both hospital and late mortality following combined MVR and CABG.
- Impaired left ventricular function, indicated by global wall motion score, is associated with increased mortality.
- Factors such as age, cause of mitral valve disease, and severity of mitral regurgitation were not found to be significant predictors in this cohort.
Abstract:
To study the effect of various perioperative and operative variables, we analysed the results of 66 consecutive patients undergoing mitral valve replacement (MVR) and coronary artery bypass grafting (CABG). The mean age was 61.2 years (34 males and 32 females), the mean follow-up 54.71 +/- 7.8 months. The hospital mortality rate was 7.6% (5/66). New York Heart Association (NYHA) functional class (P < 0.01), left ventricular global wall motion score (increased scores indicating impaired function, P = 0.005) and cross-clamp time (P < 0.05) were associated with hospital mortality. There was no significant relationship of age (certainly up to the age of 70), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, presence of angina, or previous myocardial infarction with hospital mortality. There were eight late deaths, survival at 1, 3 and 5 years was 92.4%, 83.2% and 80.2%, respectively. Although there was a trend for pulmonary vascular resistance (P = 0.15), NYHA class (P = 0.18) and aortic cross-clamp time (P = 0.09) to be associated with late survival, the only factor significantly related to late survival was global wall motion score (P = 0.001), i.e. those with scores of more than 10. Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival in patients undergoing combined CABG and MVR, but we have found no such relationship. Our results indicate that both hospital and late mortality after this operation are strongly correlated with left ventricular function.