ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The Risk Factors of Combined Valve Replacement and Coronary Artery Bypass Grafting
Gökçen ORHAN, Serap Aykut AKA, Hakkı AYDOĞAN, Uğur FİLİZCAN, Nurşin KAYNARCA, Yıldırım CÖMERTOĞLU, Okan YÜCEL, E. Ergin EREN
Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Merkezi
We know that when coronary artery disease accompanies with the valvular heart disease, the mortality and morbidity rate increase. In this study we examined 49 patients with CAD and valvular heart disease together according to their preoperative, operative and postoperative characteristics, between January 1994 and May 1998 at Dr. Siyami Ersek Hospital. We tried to find out the risk factors that affect the results of the operations.

The mean age of patients was 64.2, and 35 of them were male (%71).There were aortic valvular lesions in 29 cases(%59.1), mitral valve lesions in 19, and aortic and mitral valve lesions together in 1 case. In 2 cases there were serious tricuspid insufficiency, either. In all cases we had CAD accompanying these lesions.

Besides CABG operations, in 29 cases we performed aortic valvular replacements, in 14 cases mitral valvular replacements, in 1 case aortic and mitral valves replacement in 2 cases we performed Tricuspid De Vega annuloplasty accompanying to mitral valve replacement. Finally in 3 cases we performed mitral ring annuloplasty accompanying to CABG operations. In 1 of the patients that had aortic valvular replacement, we performed Benthall operation, too. In an other patient of aortic group, we replaced ascending aorta with a tube graft. Of the prosthesis we used, 43 were mechanical, 3 were bioprosthesis and 3 were flexible mitral ring. The mean number of the distal anastomosis done was 1.8.

Except 2 cases that had been done under blood cardioplegia in all cases we used 28 C systemic hypothermia, antegrad crystalloid cardioplegia ana topical hypothermia in order to accomplish the cardiac arrest and myocardial protection. The mean cross clamp time was 72 min. and the mean total bypass period was 91 min.

The perioperative mortality rate was % 8.16 (in 4 cases). The reasons of excitus were low cardiac output in 2 cases, infection in 1 case and acute inferior myocardial infarction in 1 case. Finally we found out that risk factors that affect the mortality and morbidity rates were mitral valve insufficiency, being in NYHA Class IV, female sexuality and long period of cross clamp time.

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