Mitral valve replacement combined with coronary artery operation: determinants of early and late results

Mitral valve replacement combined with coronary artery bypass grafting has been reported as being associated with a higher mortality than either mitral valve replacement or coronary artery bypass grafting alone. Cause of mitral valve disease and severity of mitral regurgitation have been reported as related to mortality. To study the correlation of the cause of mitral valve disease and severity of mitral regurgitation to hospital mortality and long-term survival, we analyzed the results of 135 patients undergoing mitral valve replacement and coronary artery bypass grafting between June 1974 and August 1989. The hospital mortality was 11.8% ( 16 135). Fifteen preoperative and operative variables were tested for correlation with hospital or late mortality using univariate tests and multivariate regression. Advanced age (>60 years), New York Heart Association functional class, and wall motion score were independently associated with hospital mortality (p < 0.05). The cause of mitral valve disease and severity of mitral regurgitation were not related to hospital mortality or long-term survival (p > 0.05). The follow-up rate was 96.6% for the hospital survivors ( 115 119). Mean follow-up was 52.6 ± 4.1 months. There were 35 late deaths. Survival was 91.9%, 89.9%, 78%, and 49.9% at 1, 2, 5, and 10 postoperative years, respectively. Preoperative New York Heart Association functional class and use of catecholamines during the postoperative intensive care period were independently related to late survival (p < 0.05). In conclusion, this study suggested that operative mortality for mitral valve replacement combined with coronary artery bypass grafting was correlated with preoperative New York Heart Association functional class, advanced age (>60 years), and wall motion score, and that long-term survival was correlated with preoperative New York Heart Association functional class and use of catecholamines postoperatively. Neither cause of mitral valve disease nor severity of mitral regurgitation was correlated with hospital or long-term survival.