Wj. Flameng et al., DETERMINANTS OF EARLY AND LATE RESULTS OF COMBINED VALVE OPERATIONS AND CORONARY-ARTERY BYPASS-GRAFTING, The Annals of thoracic surgery, 61(2), 1996, pp. 621-628
Background. Factors determining the outcome of operative correction of
valvular abnormalities combined with coronary artery bypass grafting
are still incompletely defined. Methods. Determinants of early and lat
e (more than 90 days) deaths and event-free survival were studied for
combined valve operations and coronary artery bypass grafting in 741 p
atients using multivariate analysis. Results. Ninety-day survival prob
ability was 89% (95% confidence interval, 87% to 92%). Preoperative ri
sk factors for early death were age, female sex, renal failure, New Yo
rk Heart Association class IV or V, and mitral insufficiency. The oper
ative risk factor was the duration of aortic cross-clamping. Five- and
10-year survival probabilities were 74% (95% confidence interval, 71%
to 78%) and 43% (95% confidence interval, 36% to 50%), respectively.
Preoperative risk factors for late death were age, preoperative renal
failure, New York Heart Association class IV or V, vessel disease, and
nonsinus rhythm. Five- and 10-year event-free survival probabilities
were 57% (95% confidence interval, 53% to 61%) and 23% (95% confidence
interval, 17% to 28%), respectively. Preoperative risk factors for no
n-event-free survival were age, female sex, reduced left ventricular f
unction, mitral regurgitation, and pacemaker rhythm. Conclusion. The d
emographic factors of age and female sex; the comorbid condition of re
nal failure; the cardiac conditions of advanced New York Heart Associa
tion class, left ventricular function, mitral regurgitation, vessel di
sease, and cardiac rhythm; and the operative condition of ischemia tim
e are the most important predictors of clinical outcome after combined
valve operations and coronary artery bypass grafting.