Wang Tom Kai Ming, Liao Yi-Wen Becky, Choi David, Harmos Sophie, Haydcok David, Gerber Ivor
Cardiologist, Department of Cardiology, Middlemore Hospital (previous Cardiology Advanced Trainee Registrar, Green Lane Cardiovascular Service, Auckland City Hospital), Auckland.
Cardiology Advanced Trainee Registrar, Department of Cardiology, Tauranga Hospital, Tauranga.
N Z Med J. 2019 Aug 16;132(1500):50-58.
A significant minority of patients undergoing mitral valve surgery (MVR) have indication for coronary artery bypass grafting (CABG). The risks of combination surgeries are not well appreciated and maybe more than additive. We compared the characteristics and outcomes of MVR+/-CABG performed at our centre.
Consecutive patients undergoing isolated MVR or with concurrent (MVR+)CABG at Auckland City Hospital during 2005-2012 were compared for baseline and operative characteristics and outcomes in univariable and multivariable analyses.
A total of 178 MVR+CABG and 407 MVR patients were included. MVR+CABG patients had higher age, CCS and NYHA Class, cardiopulmonary bypass time, and higher prevalence of urgent surgery, hypertension, diabetes, renal impairment, myocardial infarction/coronary artery disease, congestive heart failure/impaired ejection fraction and peripheral vascular disease, although lower prevalence of active endocarditis and previous valve surgery (all P<0.05). MVR+CABG had higher mortality (operative 11.2% vs 2.5% P<0.001; one and five-year survival 85% vs 96% and 78% vs 87% P=0.041) and composite morbidity 53.4% vs 18.9% P<0.001, including acute renal failure, prolonged ventilation, return to theatre (all P<0.001) but not stroke. In multivariable analyses, MVR+CABG was independently associated with higher operative mortality odds ratio 2.07 95% confidence interval 1.09-3.93 and composite morbidity 2.38 (1.03-5.47), but not long-term mortality.
MVR+CABG compared to MVR patients had more comorbidities and greater operative risk, and were independently associated with higher operative mortality and composite morbidity, but not independently associated with higher long-term mortality.
接受二尖瓣手术（MVR）的患者中有相当一部分有冠状动脉旁路移植术（CABG）的指征。联合手术的风险尚未得到充分认识，可能超过风险叠加。我们比较了在我们中心进行的MVR±CABG的特征和结果。
对2005年至2012年期间在奥克兰市医院接受单纯MVR或同期（MVR +）CABG的连续患者进行单变量和多变量分析，比较其基线、手术特征和结果。
共纳入178例MVR + CABG患者和407例MVR患者。MVR + CABG患者年龄更大，CCS和NYHA分级更高，体外循环时间更长，急诊手术、高血压、糖尿病、肾功能损害、心肌梗死/冠状动脉疾病、充血性心力衰竭/射血分数降低和外周血管疾病的患病率更高，尽管活动性心内膜炎和既往瓣膜手术的患病率较低（所有P<0.05）。MVR + CABG的死亡率更高（手术死亡率11.2% 对2.5%，P<0.001；1年和5年生存率85% 对96% 和78% 对87%，P = 0.041），复合发病率为53.4% 对18.9%，P<0.001，包括急性肾衰竭、通气时间延长、返回手术室（所有P<0.001），但不包括中风。在多变量分析中，MVR + CABG与更高的手术死亡率比值比2.07（95%置信区间1.09 - 3.93）和复合发病率2.38（1.03 - 5.47）独立相关，但与长期死亡率无关。
与MVR患者相比，MVR + CABG患者合并症更多，手术风险更大，与更高的手术死亡率和复合发病率独立相关，但与更高的长期死亡率无独立相关性。
