Combined Valve Replacement and Myocardial Revascularization: Factors Influencing Early and Late Results

Abstract

The risk factors involved in simultaneous valve replacement and coronary artery bypass grafting were evaluated in 54 consecutive patients, 42 men and 12 women, aged 22 to 73 years. The predominant valve anomalies were aortic stenosis (30 patients), aortic regurgitation (9), mitral regurgitation (10) and mitral stenosis (5). All the patients had angina. Myocardial infarction had occurred in 22 cases and was impending at the time of operation in 10. The diseased valves were replaced with mechanical prostheses, and on average 2.5 coronary arteries per patient were bypassed with vein or with internal mammary artery grafts. Four of the 54 patients died in association with surgery, and four more during follow-up (0.5-6 years). The operative mortality was 2/39 in the aortic valve group and 2/14 in the mitral valve group. The late mortality was equal in both groups. A relatively small ejection fraction and long aortic cross-clamping were the only factors which attained statistical significance as surgical risks, but mitral regurgitation due to ischaemic papillary muscle dysfunction, advanced rheumatic mitral regurgitation and tight aortic stenosis combined with coronary artery disease also seemed to be indicators of poor prognosis.

Coronary Artery Disease and Outcomes of Aortic Valve Replacement for Severe Aortic Stenosis

“…Current guidelines recommend bypass of all significant stenoses at the time of AVR, with evidence level C (4); however, addition of coronary artery bypass grafting (CABG) to AVR is associated with elevated short- and long-term mortality (5–10). This association may be causal (e.g., by increasing myocardial ischemic time (11)) or simply a marker for a high-risk patient profile. Clarifying this may lead to more targeted diagnostics, therapy, and chronic disease management.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Several studies have reported the outcomes of patients undergoing combined CABG and AVR. Although combined myocardial revascularization and AVR increases cross-clamp time 1036 and has the potential to increase perioperative myocardial infarction and early postoperative mortality compared with patients without CAD undergoing isolated AVR, [1037][1038][1039][1040] in several series, combined CABG has had little or no adverse effect on operative mortality. [1041][1042][1043][1044][1045][1046][1047] Moreover, combined CABG and AVR reduces the rates of perioperative myocardial infarction, operative mortality, and late mortality and morbidity compared with patients with significant CAD who do not undergo revascularization at the time of AVR.…”