Abstract
Background: The aim of this study was to evaluate the impact of additional coronary revascularization on the early results in patients submitted to valve surgery. Patients and Methods: A retrospective review of the cardiac surgical database between January 2000 and December 2018 was performed. A total of 1667 patients were included and divided into two groups: Group A isolated valve surgery (IVS n = 1608) and Group B with valve surgery combined to coronary artery bypass grafting (VS + CABG n = 59). Demographic, operative data and postoperative outcomes were compared between groups. Results: Patients with combined procedure were older than patients who underwent isolated valvular surgery (64.9 ± 9.2 years vs 44.4 ± 13.1 years; p = 0.0001) and there was a higher proportion of diabetics (40.7% vs 6.6%; p = 0.0001). The 30 days mortality rate in the combined procedure group was 18.6% versus 6.2% in isolated valve surgery (p = 0.001). Also post-operative complications were more frequent than for patients who underwent IVS. Additionally we noted a high prevalence of coronary artery risk factors in patients with combined procedures. Conclusion: Surgical mortality and morbidity of coexisting coronary and heart valve disease were substantially higher than IVS. More efforts in medical management may reduce the incidence of adverse outcomes.
Highlights
In developing countries, rheumatic heart disease prevails as the main cause of valvular heart disease (VHD) [1]
Patients with combined procedure were older than patients who underwent isolated valvular surgery (64.9 ± 9.2 years vs 44.4 ± 13.1 years; p = 0.0001) and there was a higher proportion of diabetics (40.7% vs 6.6%; p = 0.0001)
Aortic Valve Replacement was more common in the VS + coronary artery bypass grafting (CABG) goup 74.5% versus 51.6% in the Isolated Valve Surgery group while Aortic and Mitral Valve Replacement was less common 6.7% versus 24.7% in the IVS group
Summary
Rheumatic heart disease prevails as the main cause of valvular heart disease (VHD) [1]. Patients undergoing heart valve surgeries are more likely to be at higher surgical risk [2] [3] compared to previous data. The most common factor influencing outcomes after heart valve surgery is coronary artery disease (CAD) [4] [5]. Isolated valvular surgery seems to have a negative impact on the operative mortality when coronary artery stenosis was neglected [6]. The purpose of the present study is to analyze the influence of coronary artery bypass grafting (CABG) on hospital mortality and morbidity in patients undergoing heart valve surgery in our institutions. Conclusion: Surgical mortality and morbidity of coexisting coronary and heart valve disease were substantially higher than IVS. More efforts in medical management may reduce the incidence of adverse outcomes
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