Combined cardiac surgery in adults, analysis of risk factors and long term results in 127 operations

ABSTRACT

A total of 127 patient underwent combined coronary artery and valvular operations at our institutions, between 1984 and 1993. Ninety patients underwent coronary artery bypass grafting [CABG] and simultaneous aortic value replacement [AV], 30 patients had CABG and mitral value repair or replacement [MV] and 7 patients had CABG combined with a double-valve operation. An average of 2.7 bypasses were done [range 1-7]. Preoperatively, 97 patients [76%] were categorized in the New York Heart Association [NYHA] functional class 3 or 4. There were 18 emergency operations and 10 reoperative procedures. In 31 patients [24%] the preoperative left ventricular ejection fraction was less than 40%. The overall hospital mortality rate was 11.8% [15/127]. The mortality group [n = 15] was compared to the group of hospital survivors [n = 112] and the following parameters were found to be significant risk factors for perioperatve mortality age >65 years [p <0.05], insulin-dependent diabetes mellitus [p <0.02], generalized arteriosclerosis [p < 0.01], preoperative NYHA functional classes 3 and 4 [p < 0.02] and double-valve procedures [p < 0.004]. Long-term follow-up revealed a 5-year survival rate of 71.5% for CABG + AV and 62.5% for CABG + MV. The 5-year event-free survival rates were 52.6 and 53.4%, respectively. This study show that, even in high-risk patients, combined valve repair/replacement and CABG surgery can be performed successfully with good, long-term results: