Determinants of Operative Survival Following Combined Mitral Valve Replacement and Coronary Revascularization

To determine the operative survival rate following combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) operation, we evaluated 100 patients, who were seen consecutively at the Peter Bent Brigham and Brigham and Women's Hospital from 1972 to 1981. There were 63 men and 37 women; the mean age was 62 years. Thirty-six patients were in New York Heart Association (NYHA) Functional Class III, and 64 were in Functional Class IV. Mitral regurgitation was predominant in 76 patients; mitral stenosis, in 24. Emergency operations were performed in 15 patients, and elective or semielective operations were performed in 85.There were 18 operative deaths (18%): 9 in patients having elective operations (10.5%) and 9 in those having emergency operations (60%; p < 0.01). Significant preoperative factors related to operative death were NYHA functional class, increased pulmonary vascular resistance, lower cardiac index, and lower ejection fraction in the nonsurvivors. The rate of survival did not differ according to sex, age, or degree of coronary artery disease. In addition, myocardial protection with potassium cardioplegia and complete coronary revascularization significantly reduced operative mortality in the elective group of patients but did not alter the mortality in the emergency group.