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[Combined valvular and coronary artery surgery]
Insights
Combined valvular and coronary surgery is necessary for patients with both conditions. While outcomes for double valve replacement were initially unsatisfactory, advancements like intra-aortic balloon pumps may improve results.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Context:
- Patients with combined valvular and coronary artery disease require complex surgical interventions.
- Surgical techniques have evolved, necessitating evaluation of historical outcomes.
- The study reviews a series of combined procedures performed between 1973 and 1986.
Purpose:
- To evaluate the outcomes of combined valvular and coronary surgery.
- To assess the necessity and efficacy of these combined procedures.
- To identify areas for potential improvement in surgical management.
Summary:
- Nine patients underwent combined valvular and coronary surgery, including aortic valve replacement (AVR), mitral valve replacement (MVR), and coronary artery bypass grafting (CABG).
- Specific procedures included Bentall operation, aorto-coronary bypass, and coronary ostial interventions.
- Retrograde cardioplegia infusion was used for coronary ostial stenoses. Early mortality occurred in one emergency case; late mortality (within 1 year) was observed in two patients due to hepatic and multiple organ failure.
Impact:
- Combined valvular and coronary surgery is deemed necessary for patients with concomitant diseases.
- While double valve replacement outcomes were not optimal, future improvements are anticipated with advanced support devices.
- This study provides historical data on combined cardiac procedures, highlighting the need for ongoing refinement of surgical strategies.
Abstract:
Combined valvular and coronary surgery were performed on 9 patients between 1973 and 1986. Valve replacements were consist of 5 AVR (including 1 translocated AVR and 1 Bentall operation), 2 MVR and 2 double valve replacement. Coronary surgery were of 6 aorto-coronary bypass using great saphenous veins, 1 innominate artery-coronary bypass using a Dacron prosthesis, 1 punch-out of coronary ostium and 1 dilatation of the left coronary ostium with a vein patch. Retrograde infusion of cardioplegic solution from the coronary sinus were done in patients with coronary ostial stenoses. One emergency case with acute cardiac failure died immediately after operation, and one with double valve and one with mitral valve replacement died of hepatic failure and multiple organ failure respectively within 1 year after surgery. Combined valvular and coronary surgery are necessary for patients with both diseases. Although the results of double valve replacement were not satisfactory, they would be improved using intra-aortic balloon pump and ventricular assist devices actively.