Technical consideration in multiple valve and coronary artery surgery

Abstract

Twelve patients at the University of Oregon Medical School Hospitals have undergone simultaneous double valve and aorto-coronary bypass graft operations. All were in Functional Class III or IV and most had angina pectoris. Nine patients had aortic and mitral valve replacement: Six patients had concomitant single aorto-coronary bypass grafts, 2 had concomitant double bypass grafts, and 1 patient had concomitant triple bypass grafting. The tenth patient had mitral valve re-replacement, tricuspid annuloplasty, and a single bypass graft. The eleventh patient had aortic valve replacement, mitral commissurotomy, and triple bypass grafting. The twelfth patient had aortic valve replacement, mitral commissurotomy, and single bypass grafting. The first 3 patients operated upon died 1, 6, and 19 days after the operation of acute myocardial infarction, low cardiac output, and related problems. The next 9 consecutive patients have survived operation. Five are in Functional Class I and 2 are in Functional Class II and free of angina 3 to 19 months later. The eighth patient is slowly improving after a prolonged, complicated hospital course. There was one late death at 6 weeks (arrhythmia). The improved survival rate is related to refinements in technique which expedite the procedure and allow maximum protection of the myocardium. Frequent intermittent coronary artery perfusion of the beating heart in conjunction with a systematic, modular approach to the procedure has allowed major cardiac reconstruction to be accomplished at low risks to the patient.