Valve replacement and myocardial revascularization. Results of combined operation in 59 patients.

Fifty-nine patients (mean age 57 years) underwent aortic valve replacement or mitral valve replacement combined with saphenous vein bypass grafting (39 single, 19 double, 1 triple) between May, 1970 and January, 1974. The hospital mortality for aortic valve replacement was 4.7% (2 of 43 patients) and for mitral valve replacement 6.3% (1 of 16 patients). There was a 21% incidence of postoperative myocardial injury in the patients with aortic valve replacement and a 6.2% incidence in the patients with mitral valve replacement. Variations in operative technique and in the methods of intraoperative myocardial preservation (coronary perfusion or profound hypothermic ischemic arrest) did not affect hospital mortality or the incidence of myocardial injury. Prolonged periods of ischemic arrest (greater than 50 minutes) were not used. The late mortality for aortic valve replacement was 16.3% (seven patients) and for mitral valve replacement 25% (four patients). There was symptomatic improvement in the majority of survivors. Operative mortality rates for the combined procedures are comparable to those from our institution for valve replacement alone.