Surgery for Combined Rheumatic Valve and Coronary Artery Disease

Abstract

Between 1986 and 1996, 147 patients underwent valve replacement combined with coronary artery bypass grafting. The mitral valve was replaced in 104 patients, the aortic valve in 34, and both mitral and aortic valves were replaced in 9. One hundred and twenty-two (83%) were male with a mean age of 56 ± 5 years (range, 38 to 77 years). The mean age for female patients was 57.9 ± 5 years (range, 38 to 70 years). All of the patients had rheumatic valve disease. Preoperatively, 68% were in New York Heart Association functional class III or IV and 32% were in class II. A total of 252 distal anastomoses were performed (mean, 1.71 per patient) in these patients of whom 48.9% had single-vessel disease, 45% had two-vessel or three-vessel disease, and 6.1% had left main coronary artery disease. The hospital mortality rate was 10.2%. Three patients died during the follow-up period and the overall actuarial survival rate at 10 years was 96.6% ± 1.9%. Operations that combine both valve replacement and coronary artery bypass are performed more frequently because perioperative risk has decreased through more effective myocardial protection. If untreated, both coronary artery disease and significant valve disease may reduce patient survival.