Predictive factors of mortality in combined coronary and vascular surgery. Report of 46 cases

From 1994 and 2003, 46 patients underwent surgical myocardial revascularisation associated to valvular surgery. Surgical indications were for valvular disease in 13 cases (28%), for coronary disease in 16 cases (35%) and associated coronary and valvular disease in 17 cases (37%); Isolated conservative mitral repair was performed in 22 cases (48%); mitral valve replacement in 10 cases (41%), aortic valve replacement in 11 cases (46%) associated mitral and aortic surgery in 3 cases (13%). Intra-aortic balloon pump was used in 4 patients (9%). In the post operative period complete atrio-ventricular heart bloc occurred in 2 cases. For the entire group, 8 deaths (17%) occurred in the hospital, related to low cardiac output in 5 cases (63%). Long term follow up was achieved in a mean period of 18 months. 25 patients (68%) were asymptomatic and one late death occurred after severe heart failure. The predictive factors of hospital mortality were: preoperative ischemic mitral insufficiency. Various large series in the literature have documented operative risk of myocardial revascularisation when combined with valve surgery. In our group the high rate of hospital mortality (17%) explains the difficulties in medical and surgical care of this combined valvular and coronary disease especially in the perioperative period.