DETERMINANTS OF EARLY AND LATE RESULTS OF COMBINED VALVE OPERATIONS AND CORONARY-ARTERY BYPASS-GRAFTING

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.