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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 951-959, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JM Arcidi Jr, RF Hebeler, JM Craver, EL Jones, CR Hatcher Jr and RA Guyton
We have favored treatment of moderate mitral regurgitation and coronary
disease with coronary bypass alone because of the high operative mortality
of combined mitral valve replacement and coronary bypass. Between 1977 and
1983, coronary bypass alone was performed on 58 patients (mean age 63 +/- 8
years). Preoperatively, 90% had Canadian Cardiovascular Society class III
or IV angina, and 10% had class III or IV congestive heart failure. In 72%
mitral regurgitation had been caused by coronary disease. Hospital
mortality was 3.4% (2/58). At follow-up (100% complete, mean 4.3 years) 66%
of survivors were functional classes I and II (compared with 7%
preoperatively, p less than 0.0001). Of those patients who worked
preoperatively, 84% returned to work. There were no reoperations. The
5-year survival was 77%. In the same period combined mitral valve
replacement and coronary bypass was required in 20 unmatched patients with
moderate mitral regurgitation and coronary disease. Indications for valve
replacement included congestive heart failure (10 cases), high left atrial
pressure (three cases), and mitral stenosis (four cases). In these patients
with more advanced symptoms the hospital mortality was 25%, and the 5-year
survival was 31%. Treatment of moderate mitral regurgitation and coronary
disease by coronary bypass alone achieved excellent hospital survival and
long-term functional stability without a subsequent valve operation.
ARTICLES
Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
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