Coronary artery bypass plus mitral valve replacement. A five-year study.

Fifty-two patients with a mean age of 67.6 years underwent coronary artery bypass plus mitral valve replacement from 2 April 1984, through 6 February 1989. All but four of these 25 males and 27 females were in the New York Heart Association Functional Classes III and IV, with presenting symptoms of angina and/or dyspnea. Twenty-four patients (44.2%) presented with acute myocardial infarctions, and eleven patients (21.2%) had a past history of rheumatic fever or rheumatic heart disease. Forty-five patients (86.5%) had a diagnosis of coronary artery disease plus mitral regurgitation. Treatment included a mean of 2.3 bypass grafts per patient plus mitral valve replacement with Carpentier-Edwards (41), St. Jude (10), and Bjork-Shiley (1) prostheses. The four operative deaths (7.7%) were attributed to congestive heart failure (1), mediastinal bleeding (1), mediastinitis (1), and stroke (1). There were eight late cardiac deaths (16.7%) and six late noncardiac deaths (12.5%), a mean of 16.6 and 18.9 months postoperatively, respectively. Thirty-four patients have survived from 10 to 65 (mean 33.7) months postoperatively with a mean New York Heart Association Functional Class 1.6. Follow-up determination of patients' attitudes toward their surgery was ascertained in 28 of the 34 survivors, and 26 (92.8%) patients indicated that they were pleased with their surgery. These results compare favorably with data reported in the recent literature. In addition, the study shows that patients requiring supportive treatment in a critical care unit preoperatively had the same operative mortality but more postoperative complications and a longer mean hospital stay than the equal number of patients who were not in a critical care unit preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)