PERIOPERATIVE MORBIDITY AND MORTALITY IN COMBINED AORTIC AND MITRAL-VALVE SURGERY

Background and aims of the study: Despite many significant improvement s in cardiac surgical technique, the operative risk for combined aorti c and mitral valve surgery remains between 5% and 12%. Identification of high-risk patients will allow surgeons to develop strategies to imp rove these results. Methods: The 30-day postoperative mortality and co mplication rates were analyzed in a group of 206 patients operated on over a 16-year period with cold crystalloid cardioplegia. Thirty-three possible risk factors for death and low output syndrome (LOS) were en tered into univariate and multivariate logistic regression analysis. R esults: There were 10 perioperative deaths (4.9%). Major complications occurred in 38 patients (18.4%), 19 with LOS. On univariate analysis, right atrial pressure (RAP) greater than or equal to 8 mmHg (p = 0.00 1), aortic stenosis (p = 0.009) and systolic pulmonary artery pressure greater than or equal to 60 mmHg (p = 0.095) were found to be risk fa ctors for death, as were RAP greater than or equal to 8 mmHg (p = 0.00 1), previous heart surgery (p = 0.007), serum creatinine greater than or equal to 120 mu mol/l (p = 0.03), tricuspid valve disease (p = 0.03 8) and aortic stenosis (p = 0.09) for LOS. On multivariate analysis, R AP greater than or equal to 8 mmHg (p <0.001) and aortic stenosis (p = 0.002) were identified as independent risk factors for death, as were RAP greater than or equal to 8 mmHg (p = 0.001) and previous heart su rgery (p = 0.008) for LOS. Conclusions: Mitro-aortic valve surgery inv olves complex procedures with substantial mortality and morbidity. The risk factors point toward the importance of operating before the stag e of advanced heart failure and toward the key role of better myocardi al protection techniques in these compromised hearts with limited rese rves.