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SURGICAL TREATMENT OF COMBINED VALVE AND CORONARY ARTERY DISEASE
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Abstract
Objective: To evaluate the results of simultaneous surgical treatment of valvular heart disease and coronary artery bypass grafting, which is one of the strategic surgical procedures and has improved over the years. Methode and materials: Retrospective study from january 2014 to december 2024, 97 patients underwent combined surgery for valvular heart disease and coronary artery disease. Valvular heart disease and coronary artery disease were diagnosed by at least 2 preoperative echocardiograms and digital coronary angiography. Coronary artery bypass grafting and replacement or repair of at least one heart valve were performed under extracorporeal circulation and moderate hypothermia. Data were collected from clinical records and processed using Kaplan Meier, SPSS 18.0. Results: The mean age was 59 ± 10.2 years, 72.6% were male. Coronary artery lesions indicated for bypass during preoperative evaluation of valvular heart disease were 85.3% and 14.7% of patients had valvular heart lesions indicated for surgery diagnosed during preoperative evaluation of coronary artery disease. Of these, 60.4% were mitral valve lesions, 37.8% were aortic valve lesions, and 1.8% were tricuspid valve lesions. The mean number of coronary artery bypass grafts performed was 1.98 ± 1.07, and the internal thoracic artery was used in 98.7% of cases. Mitral valve repair (33%), mitral replacement (21.6%), aortic valve replacement (27.9%), mitral replacement - aortic replacement (6.3%), aortic valve replacement - mitral repair (8.3%). The time of extracorporeal circulation was 163.6 ± 66.7 minutes, the time of aortic clamping: 98 ± 57.3 minutes. The early mortality rate was 2.1% (2 patients), and the cause was renal failure (1.1%), parosxysmal hyper-bilirubinemia (1.1%). 4 patients were lost to follow-up (4.1%), the mean follow-up time was 96.6 ± 42.7 months (6-156 months), the late mortality rate in 2 patients (2.1%), Kaplan Meier estimated survival rates at 1 year, 5 years and 10 years were 92.6%, 89.3% and 85.1%, respectively. Conclusion: Heart valve repair or replacement surgery combined with coronary artery bypass grafting is a safe, effective and optimal surgery in the treatment of combined valvular and coronary artery disease. The low surgical mortality and good longterm results mean that simultaneous valve-coronary surgery should be performed early before myocardial function declines and this does not affect long-term survival.
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2. Wendt, D.; Kahlert, P.; Lenze, T.; Neuhauser, M.; Price, V.; Konorza, T.; Erbel, R.; Jakob, H.; Thielmann, M. Management of high-risk patients with aortic stenosis and coronary artery disease. Ann. Thorac. Surg. 2013, 95, 599–605.
3. Jennifer S. Lawton, Chair, Jacqueline E. Tamis-Holland, Eric R. Bates, Theresa M. Beckie, James M. Bischoff, John A. Bittl, and Brittany A. Zwischenberger. ACC/AHA/SCAI 2021.Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, Circulation, Volume 145, Number 3.
4. Formica, F.; Mariani, S.; D’Alessandro, S.; Singh, G.; Di Mauro, M.; Cerrito, M.G.; Messina, L.A.; Scianna, S.; Papesso, F.; Sangalli, F. Does additional coronary artery bypass grafting to aortic valve replacement in elderly patients affect the early and long-term outcome? Heart Vessels 2020, 35, 487–501.
5. Fournier JA, Cabezón S, Cayuela A, Ballesteros SM, Cortacero JA, Díaz De La Llera LS. Long-term prognosis of patients having acute myocardial infarction when =40 years of age. Am J Cardiol 2004;94:989–992.14-18.
6. Keith M Channon, David E Newby, Edward D Nicol, John Deanfield. Cardiovascular computed tomography imaging for coronary artery disease risk: plaque, flow and fat. Heart. 2022 Sep 12;108(19):1510-1515. doi: 10.1136/ heartjnl-2021-320265.
7. Kyriakos Spiliopoulos, Dimitrios Magouliotis, Ilias Angelis, John Skoularigis, Bernhard M. Kemkes, Nikolaos S. Salemis, Thanos Athanasiou, Brigitte Gansera and Andrew V. Xanthopoulos. Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients. J. Clin. Med. 2024, 13(1), 238.
8. Thalji, N.M.; Suri, R.M.; Daly, R.C.; Greason, K.L.; Dearani, J.A.; Stulak, J.M.; Joyce, L.D.; Burkhart, H.M.; Pochettino, A.; Li, Z.; et al. The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: Implications for revascularization in the transcatheter era. J. Thorac. Cardiovasc. Surg. 2015, 149, 451–460.
9. Davarpasand, T.; Hosseinsabet, A.; Jalali, A. Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: Short- and mid-term outcomes. Interact. Cardiovasc. Thorac. Surg. 2015, 21, 322–328.
10. Ruel M, Kulik A, Lam BK, Rubens FD, Hendry PJ, Masters RG, et al. Long-term outcomes of valve replacement with modern prostheses in young adults. Eur J Cardiothorac Surg 2005;27:425–433.