Coronary artery bypass grafting combined with valvular surgery the challenge of reoperative surgery

ABSTRACT

Untreated or undetected coronary artery stenosis has been blamed for death or failure to improve following valve replacement/repair. Combined surgery [CABG + valve] has therefore been introduced. With an increasing number of patients requiring cardiac surgery for the second time [REDO's], the present study was undertaken to evaluate results after primary and REDO combined cardiac surgery. A total of 138 patients underwent combined coronary artery and valvular operations between January 1, 1984 and December 31, 1993. one hundred twenty-four patients had primary surgery [Gr. I] and 14 operations were REDO's [Gr. II], 10.2%. there were73% coronary artery bypass grafting [CABG] and simulataneous aortic valve replacement [AV], 23% CABG + mitral valve repair/ replacement [MV] and4% had CABG combined with double valve replacement [DV], with a similar incidence in both groups. The average age in Gr. I was 66.9 +/- 10.2 compared to 67.7 +/- 7.3in GR. II. [n. s.]. sex distribution and prop. Risk factors did not differ between the groups. Seventy-five% of the patients were in prop. NYHA class 3 and 4 in both groups and there was 15% urgent operations performed. Preop. Left ventricular ejection fraction was 42.2 +/- 18.9% in Gr. I and 52.9 +/- 9.5%, p<0.001. Gr I patients received 2.7 +/- 1.4 grafts/ patient, while Gr. II patients had 1.4 +/- 0.8grafts/patient, p<0.001. other operative data did not differ. The overall mortality was 10.4% in Gr I and 21.4% in Gr II, p<0.05 low cardiac output was frequently observed, 23% in both groups, while the incidence of other postoperative complications was low and did not differ significantly between the groups. Significant risk factors for perioperative mortality in Gr. I were Age>65 years [p<0.001], CABG + DV[p<0.001], LVEF<40% [p<0.05], and in Gr. II Age>65 years [p<0.001], p<0.05. 3-years survival and event-free survival rates were good in both groups. Combined valve repair/replacement and CABG surgery is associated with a 11%perioperativee mortality but encouraging long term results. REDO combined cardiac surgery carries significant mortality, but could be considered in selected patients because of excellent long-term results. Double valve procedures not recommended in combined cardiac surgery reoperations