Article

lock Open Access lock Peer-Reviewed

374

Views

ORIGINAL ARTICLE

Combined coronary and valvular surgery

Pablo M. A PomerantzeffI; Miguel Antônio MorettiI; Paulo Moniz de Aragão PorciunculaI; Carlos Manoel de Almeida BrandãoI; José Antônio F RamiresI; Noedir A. G StolfI; Adib D JateneI

DOI: 10.1590/S0102-76381994000400004

ABSTRACT

In the period between July 1980 and June 1989,172 consecutive patients were submitted to combined coronary and valvular surgery. There were patients with predominantly valvular indications and others with predominant coronary indications. In 95 cases, myocardial revascularization and surgical treatment of the aortic valve (RAo) were simultaneously performed. Seventy five patients were submitted to myocardial revascularization and surgical treatment of the mitral valve (RMi). The more frequent valvular lesions were aortic stenosis (44 cases) and mitral insufficiency (40 cases). The mean number of anastomoses per patient was 1,87 for RMi cases and 1,56 for RAo patients. Overall hospital mortality was 9,8%; RAo mortality was 7,3% and RMi mortality was 12%. Mortality of patients with ischemic mitral insufficiency operated on electively (20%) or in an emergency basis (37,5%) was not statistically significant (x2=04423). There was not a relationship between mortality and the number of anastomoses per patient. A tendency for better results regarding mortality was observed in RMi patients in which the valve was preserved (x2=1,6382). The survival actuarial curves in 19 semesters demonstrates a valve of 82,6% for RMi patients, 90,4% for RAo patients and 86,3% for the whole series. After evolution of 5172 months/patients, 75% were in functional class I (NYHA).

RESUMO

Este trabalho analisa 172 pacientes consecutivos operados de cirurgia valvar e coronária simultânea, no período compreendido entre julho de 1980 e junho de 1989.0 número de pacientes submetidos a revascularização do miocárdio e tratamento cirúrgico da valva aórtica (RAo) foi de 95, sendo que 75 foram submetidos a tratamento cirúrgico da valva mitral e revascularização do miocárdio (RMi). As lesões valvares mais freqüentes foram a estenose aórtica, 44 casos de insuficiência mitral em 40 casos. O número de anastomoses por paciente foi de 1,87 em média para os pacientes RMi e de 1,56 nos pacientes RAo. A mortalidade hospitalar foi de 9,8% sendo que a mortalidade para os pacientes RAo foi de 7,3% e para os pacientes RMi foi de 12%. Não houve diferença significativa (x2=04423) entre a mortalidade dos pacientes portadores de insuficiência mitral isquémica, operados eletivamente ou em caráter de emergência, sendo a mortalidade de 20% nos eletivos e de 37,5% nos de emergência. Não houve relação entre mortalidade e número de anastomoses por paciente. Houve tendência de melhores resultados com relação à mortalidade nos pacientes RMi com cirurgia conservadora (x2=1,6382). A curva actuarial de sobrevida mostra 82,6% em 19 semestres para os pacientes RMi, 90,4% para os pacientes RAo e 86,3% para o estudo global de pacientes. Com uma evolução de 5172 meses/pacientes, 75% apresentam-se em classe funcional I (NYHA).
Full text available only in portuguese PDF format.

REFERENCES

1. AKINS, C. W.; BUCKLEY, M. J.; DAGGETT, W. M.; AUSTEN, W. G.; HILGENBERG, A. D.; JACOBS, M. L. - Ten year follow-up of the Starr-Edwards prosthesis. Heart valve replacement: current status and future trends. In: RABAGO, G. & COOLEY, D. A. (eds.) Futura Publishing Company Inc. Mount Kisko N. Y. 1987.

2. CZER, L. S. C. & MATLOFF, J. M. - Combined valvular and coronary surgery. Chest, 90: 312-314, 1986. [MedLine]

3. DISESA, V. J.; COHN, L. H.; COLLINS, J. J.; KOSTER, J. K.; VAN DEVANTES, S. - Determinants of operative survival following combined mitral valve replacement and coronary revascularization. Ann. Thorac. Surg., 34: 482-489, 1982. [MedLine]

4. GOOR, D. A.; MOHR, R.; LAVEE, J.; SERRAF, A.; SMOLINSKY, S. - Preservation of the posterior leaflet during michanical valve replacement for ischemic mitral refurgitation and complete myocardial revascularization. J. Thorac. Cardiovasc. Surg., 96: 253-260, 1988. [MedLine]

5. KAY, J. H.; ZUBIATE, P.; MENDEZ, M. A.; VANSTROM, N.; YOKOYAMA, T.; GHARAVI, M. A. - Surgical treatment of mitral insuficiency secondary to coronary artery disease. J. Thorac. Cardiovasc. Surg., 79:12-18, 1980. [MedLine]

6. LYTLE, B. W.; COSGROVE, D. M.; GILL, C. C; STEWART, R. N.; GOLDING, L. A. R.; GOORMASTIC, M.; TAYLOR, P. C; LOOP, F. D. - Mitral valve replacement combined with myocardial revascularization: early and late results for 300 patients: 1970 -1983. Circulation., 71: 1179-1190, 1985. [MedLine]

7. LYTLE, B. W.; COSGROVE, D. M.; LOOP, F. D.; TAYLOR, P. C; GILL, C. C; GOLDING, L. A. R.; GOORMASTIC, M.; GROVES, L. K. - Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients: 1967-1981. Circulation., 68: 1149-1162, 1983. [MedLine]

8. MULLANY, C. J.; ELVEBACK, L. R.; FRYE, R. L; PLUTH, J. R.; EDWARDS, W. D.; ORSZULAK, T. A.; NASSEF, L. A.; RINER, R. E.; DANIELSON, G. K. - Coronay artery disease and its management: influence on survival in patients undergoing aortic valve replacement. J. A. C. C, 10: 66-72, 1987.

9. ORSZULAK, T. A.; SCHAFF, H. V.; DANIELSON, G. K.; PIEHLER, J. M.; PLUTH, J. R.; FRYE, R. L; MCGOON, D. C. - Mitral regurgitation due to ruptured chordae tendinae: early and late results of valve repair. J. Thorac. Cardiovasc. Surg., 89: 491-498, 1985. [MedLine]

10. TSAI, T. P.; MATLOFF, J. M.; CHAUX, A.; KASS, R. M.; LEE, M. E.; CZER, L. S. C; DeROBERTIS, M. A.; GRAY, R. J. - Combined valve and coronary artery by pass procedures in septuagenarians and octogenarians: results in 120 patients. Ann. Thorac. Surg., 42: 681-684, 1986. [MedLine]

Article receive on Thursday, December 1, 1994

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY