Determinants of early and late results of combined valve operations and coronary artery bypass grafting

doi:10.1016/0003-4975(95)00970-1

The Annals of Thoracic Surgery

Volume 61, Issue 2, February 1996, Pages 621-628

https://doi.org/10.1016/0003-4975(95)00970-1 Get rights and content

Background.

Factors determining the outcome of operative correction of valvular abnormalities combined with coronary artery bypass grafting are still incompletely defined.

Methods.

Determinants of early and late (more than 90 days) deaths and event-free survival were studied for combined valve operations and coronary artery bypass grafting in 741 patients using multivariate analysis.

Results.

Ninety-day survival probability was 89% (95% confidence interval, 87% to 92%). Preoperative risk factors for early death were age, female sex, renal failure, New York Heart Association class IV or V, and mitral insufficiency. The operative risk factor was the duration of aortic cross-clamping. Five- and 10-year survival probabilities were 74% (95% confidence interval, 71% to 78%) and 43% (95% confidence interval, 36% to 50%), respectively. Preoperative risk factors for late death were age, preoperative renal failure, New York Heart Association class IV or V, vessel disease, and nonsinus rhythm. Five- and 10-year event-free survival probabilities were 57% (95% confidence interval, 53% to 61%) and 23% (95% confidence interval, 17% to 28%), respectively. Preoperative risk factors for non—event-free survival were age, female sex, reduced left ventricular function, mitral regurgitation, and pacemaker rhythm.

Conclusion.

The demographic factors of age and female sex; the comorbid condition of renal failure; the cardiac conditions of advanced New York Heart Association class, left ventricular function, mitral regurgitation, vessel disease, and cardiac rhythm; and the operative condition of ischemia time are the most important predictors of clinical outcome after combined valve operations and coronary artery bypass grafting.

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2016, Journal of the American College of Cardiology
Citation Excerpt :
As the authors reported, “This is equivalent to almost one-third of all patients developing significant recurrent MR by 20 years.” Despite this, the excellent results of this world-class master technician’s repair experience have been difficult to match by others to date (14,23,24). The predictors of MR recurrence in our large multisurgeon series were strikingly similar.
The risk for and consequences of recurrent mitral regurgitation (MR) following degenerative mitral valve repair are poorly understood.
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We evaluated patients undergoing primary mitral repair for isolated degenerative MR over 1 decade. Median follow-up was 11.5 years (interquartile range: 9.2 to 13.6 years) and was 99% complete. Multivariate analysis of post-repair MR recurrence employed Cox proportional hazards and multistate modeling.
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Our study demonstrated that recurrent MR following degenerative mitral valve repair is associated with adverse left ventricular remodeling and late death. The incidence of MR recurrence decreases markedly following the first year after intervention. A transparent discussion of recurrent MR risk has pressing relevance when referring patients with complex mitral valve prolapse.
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One hundred patients underwent minimally invasive isolated aortic valve replacement. Of these, 50 patients received a Perceval (Sorin Group, Saluggia, Italy) bioprosthesis (group P) and 50 patients received a non-Perceval valve (group NP).
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Sutureless implantation of the Perceval valve is associated with shorter cross-clamp and cardiopulmonary bypass times, resulting in improved clinical outcome. In addition, it compares favorably with conventional valves in terms of mortality and outcome variables.
Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: A systematic review and meta-analysis of 40 studies
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Citation Excerpt :
Indeed, prolonged cross-clamping time is known to negatively affect the short-term outcome after adult cardiac surgery because of the related myocardial ischemia-reperfusion injury and the systemic inflammatory effect of prolonged cardiopulmonary bypass time.56,57 Very elderly patients are particularly exposed to intraoperative myocardial ischemia,58 and the benefit of reduced exposure to ischemic insult might be especially evident in those undergoing combined AVR and CABG.59 Interestingly, the herein included series reported mean cross-clamping time ranging from 6225 to 96 minutes13; therefore, there are potentials for decreasing the duration of myocardial ischemia.
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This is a systematic review of the literature and meta-analysis of data on patients aged ≥80 years who underwent combined AVR and CABG.
The literature search yielded 40 observational studies reporting on 8,975 patients aged ≥80 years. Pooled proportion of immediate postoperative mortality was 9.7% (95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was 8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and 10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P = .043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies, 2,770 patients), and postoperative implantation of pacemaker was 4.3% (95% CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5 studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%, respectively.
Conventional AVR and CABG in patients aged ≥80 years are associated with significant operative mortality and morbidity as well as prolonged in-hospital treatment. However, conventional surgery is associated with remarkably good late survival. This suggests that any alternative treatment modality must prove itself of being enough durable also in the very elderly.
Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes
2011, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
These possible complications of the TAV technology justify the search for an alternative technique to safely replace the aortic valve in high-risk candidates for open surgery. We know from previous studies that the duration of aortic crossclamping and CPB are independent predictors of survival after valve replacement and combined valve operations with CABG.7 Therefore, a technology focused on shortening aortic crossclamp time and consequently CPB time is mandatory.
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The Perceval S valve (Sorin Biomedica Cardio Srl, Sallugia, Italy), a sutureless implantable aortic bioprosthesis, was used in 32 patients (median age, 78 years; median logistic euroSCORE, 9.99) requiring aortic valve replacement with or without concomitant coronary artery bypass grafting. Hemodynamic parameters and clinical outcome were obtained at discharge, at 6 months, and up to 1 year postoperatively.
Aortic crossclamp time needed for aortic valve replacement was 18 ± 6 minutes. Hemodynamics at discharge showed good function of all Perceval S valves with low transvalvular pressure gradients (mean, 12 ± 5 mm Hg and peak, 23 ± 9 mm Hg) and low incidence of paravalvular or valvular leakage. Operative mortality was 0%. Follow-up at 1 year showed 3 non–valve-related deaths. Survivors showed good clinical outcome and stable hemodynamic function of the valve prosthesis, except for 1 patient in whom endocarditis developed. Despite a moderate decrease in platelet counts persisting up to 12 months, freedom of bleeding and thromboembolic events was 100%.
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Rats were infused with doses of HBOC or saline through femoral vein injection (n = 5 per group). Animals were sacrificed and organs were flushed. Heart, lung, and brain samples were taken for evaluation of total organ levels of HO-1 induction and for histologic localization of the cellular expression of the HO-1. Heat shock protein 72 levels were also analyzed to determine whether HO-1 induction was a generalized stress response.
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Original article: CardiovascularDeterminants of early and late results of combined valve operations and coronary artery bypass grafting

Background.

Methods.

Results.

Conclusion.

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Am Coll Cardiol

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularisation

Circulation

Ten-year survival following aortic valve replacement: a multivariate analysis of coronary bypass as a risk factor

J Cardiovasc Surg

Combined aortic valve replacement and myocardial revascularization: results in 220 patients

Circulation

Early results of aortic valve replacement with or without concomitant coronary bypass grafting

Scand J Thorac Cardiovasc Surg

Combined valve and coronary artery bypass surgery: early and late results

Eur J Cardiothorac Surg

Nucleoside transport inhibition mediates lidoflazine-induced cardioprotection during intermittent aortic cross-clamping

J Thorac Cardiovasc Surg

Detection of hypokinesis by a quantitative analysis of left ventricular cineangiograms

Circulation

Original article: Cardiovascular
Determinants of early and late results of combined valve operations and coronary artery bypass grafting