Does combined valve and coronary artery bypass surgery increase mortality? Early and late results of an analysis in 847 patients

Objective: Aim of the study was to describe mortality early and late after combined valve surgery with a mechanical prosthesis and coronary artery bypass grafting (CABG) as compared with valve replacement (VR) alone.

Methods: We reviewed retrospectively the mortality of 294 patients who underwent combined valve and CABG surgery at our department and compared them with 553 patients who underwent valve replacement (VR) in the same period (01/1993–10/2000).

Results: There were 208 men (70.7%) and 86 women (29.3%) (mean age: 65.4+8.5y, range: 25.6–85.9y). 201 patients (68.4%) underwent aortic valve replacement (AVR) and coronary artery bypass grafting (CABG), 63 patients (21.4%) had mitral valve replacement (MVR) and CABG and 30 patients (10.2%) underwent double valve replacement (DVR) and CABG. The VR group consists of 387 AVR, 118 MVR and 48 DVR. Cumulative duration of follow up is 1197 patient-years (py) (maximum: 9y). Overall hospital mortality (30 days) rate was 6.8% (n=20) in VR-CABG, and 4.2% (n=32) in VR-patients. Regarding late mortality: 42 VR-CABG-patients (14.28%) and 43 VR-patients (7.7%) died during the follow up. At follow up 78% of VR-CABG survivors were in NYHA class I or II. Cumulative survival rate at 9.1y was for AVR-CABG: 71.8% vs. AVR: 80.7% (p: 0.051), for MVR-CABG: 67% vs. MVR: 96.4% (p: 0.0122) and for DVR-CABG: 64.3% vs. DVR: 76.4% (p: 0.81). Multivariable logistic analysis identified high age at operation (>70y) in the VR-CABG group as an independent mortality risk factor (p: 0.034).

Conclusions: VR-CABG has diminished early and late survival in comparison to VR surgery. Advanced age at operation was identified as an independent mortality risk factor after combined VR-CABG surgery.