Combined open-heart valve surgery and elective abdominal operations.

From January 1970 to December 1984, at the "A. De Gasperis" Division of cardiac surgery in 73 patients an open-heart valvular operation and an elective abdominal surgical procedure were simultaneously performed. Abdominal surgery was indicated for: cholelithiasis (41 cases), hernia (22 cases), uterine fibroleiomyomas (7 cases), pregnancy (1 case), marginal ulcer after gastric resection (1 case), association of cholelithiasis and hernia (1 case). The etiology of valvular disease was: previous rheumatic fever (69 cases) and acute bacterial endocarditis (1 case); there were 3 cases of periprosthetic leak. All patients were classified in NYHA class III or IV. In all patients the abdominal procedure was carried out first. No significant differences were noted between this group of patients and patients with isolated open-heart operations regarding: postoperative bleeding, stay in Postoperative Intensive Care Unit, overall postoperative hospital stay. There were 5 hospital deaths, all related to cardiac causes. There were no infectious complications, nor early or late abdominal wound complications. The rationale for the combined approach to abdominal and cardiac diseases includes: risk of non cardiac surgery in patients with critical heart disease, risk of non cardiac surgery in patients with previous cardiac valve operations and anticoagulant therapy and risk of abdominal complications after cardiopulmonary bypass surgery. Simultaneous abdominal and cardiac surgery is suggested on clinical, psychological and social grounds.