The Annals of Thoracic Surgery, Vol 23, 20-25, Copyright © 1977 by The Society of Thoracic Surgeons
Combined procedure of coronary artery bypass grafting and valve repair
JM Ciaravella Jr, JL Ochsner and NL Mills
The safety of combined operative procedures for valvular and coronary
artery disease was reviewed in 27 patients. Twelve patients had aortic
valve disease and 15 had mitral valve disease. Forty-seven coronary artery
reconstructions were performed, and average of 1.7 per patient. Twenty-two
patients underwent valve replacement and 5 had valvuloplasty. Congestive
heart failure was the major symptom in 20 patients, and angina was the
major symptom in 7. Eight of the patients with congestive heart failure had
no angina, but significant coronary stenoses were demonstrated at routine
coronary angiography. Coronary reconstruction was performed before valve
repair. Two patients died postoperatively (a hospital mortality of 7.4%),
and there were 4 late deaths from 2 to 28 months postoperatively. There
were no postoperative myocardial infarctions. Contrary to previous reports,
coronary artery reconstruction and valve repair need not be associated with
an increased risk. Protection of the myocardium by coronary perfusion
through reconstructed coronary arteries enables valve repair to be done
without greater risk than valve repair alone. All patients considered for
valve repair should have coronary angiography.
