Aorto-coronary vein bypass and valvular surgery.

During the period 1972--1975, 26 patients underwent valvular surgery combined with aorto-coronary saphenous vein bypass at Ullevål Hospital, Oslo. Aortic valve replacement was performed in 13 patients, mitral valve replacement in 8 and double valve replacement in 3 patients. The Björk-Shiley tilting disc valve was used in all cases. A Carpentier ring was inserted in one case and an open mitral commissurotomy was performed in another. Twenty-nine saphenous vein grafts were inserted. Three early deaths (all patients in functional class IV (NYHA)) were due to myocardial failure. There were 2 late deaths (both patients in functional class III before operation) of which one was due to myocardial infarction and the other to ventricular fibrillation. The overall mortality was 19%. At follow-up with a mean observation time of 11 months, 19 of the 21 survivors were improved at least one functional class. Only 2 patients had mild angina pectoris. No valvular dysfunction was found. Twenty-one of 22 re-examined grafts were patent (95% graft patency). Valvular surgery combined with aorto-coronary vein bypass in this material shows low mortality and good clinical and haemodynamic results in patients in functional class II and III. Patients should be operated upon before they reach functional class IV, as the mortality in that group is very high.