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Ann Thorac Surg 1987;43:353-358
© 1987 The Society of Thoracic Surgeons

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Articles

The Determinants of Mortality and Morbidity after Multiple-Valve Operations

Division of Cardiovascular Surgery, Toronto General Hospital, and the University of Toronto, Toronto, Ontario, Canada

Accepted for publication March 31, 1986.

^* Address reprint requests to Dr. Weisel, Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, Eaton North 13-224, Toronto, Ontario, Canada, M5G 2C4

The factors predictive of hospital mortality and morbidity after contemporary multiple-valve surgical procedures were identified to develop strategies to improve the results of such procedures. Preoperative, intraoperative, and postoperative information was collected prospectively on 90 consecutive patients undergoing surgical procedures between 1982 and 1984. The operative mortality was 5.6%, and the incidence of postoperative low-output syndrome was 16.7%. Multivariate logistic regression analysis identified tricuspid regurgitation (p < .03, improvement-of-fit chi square) and the aortic valve lesion (p < .03) as the independent predictors of postoperative complications (mortality or low-output syndrome). Patients with tricuspid regurgitation and right ventricular decompensation and those with aortic stenosis and left ventricular hypertrophy had limited ventricular functional reserve and faced an increased risk. Improved methods of myocardial protection may reduce the risk in these patients.

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