Valve Replacement and Coronary Revascularization: Combined Surgical Approach

Report is presented of sixteen patients who had coronary bypass procedures performed in combination with valvular surgery. There was a hospital mortality of two patients of 12.5%. Significant improvement occurred in the remaining fourteen patients or 87.5%. Of these fourteen patients, one patient required re-operation for mitral valve replacement following an open mitral commissurotomy two years previously. Coronary arteriosclerosis complicating the outcome of patients undergoing valvular surgery is well recognized (1). Hall and associates (2) reported the results of seventy-two patients undergoing combined procedures with seventeen operative deaths, an operative mortality rate of 23.6%. Merin's group (3) reported on a series of fifty patients from the Mayo Clinic with an operative mortality rate of 14%. Loop and coworkers (4) reported an operative mortality rate of 8% in fifty patients undergoing combined procedures. Crouch and associates (5) reported on thirty-six patients with four hospital deaths, an operative mortality of 11%. At the Heart Institute of Michigan, five hundred fifty-six patients under-went coronary bypass surgery from December, 1969 to September, 1974. This is an all inclusive, consecutive experience. Overall mortality in this group was nine patients or 1.6%. Of five hundred forty patients who did not have associated valvular surgery, the mortality was seven patients or 1.3%. The purpose of this presentation is to elaborate on the sixteen patients who had coronary surgery combined with valvular surgery. Mortality in this group was two patients or 12.5%.