Results of combined valve replacement and myocardial revascularization. Relation to method of myocardial protection.

One hundred and twenty-three patients underwent combined valve and coronary artery bypass surgery, between 1974 and 1985. Seventy patients had aortic valve replacement, 53 had mitral valve replacement; 63.4% were male and 45% were over 60 years (mean 59 +/- 2 years). Ischaemic cardiac arrest was used in 21 patients (Group I), cold crystalloid cardioplegia in 51 (Group II), and cold blood cardioplegia in 51 (Group III). Group III had a greater number of patients with poor preoperative functional status and left ventricular function. Early mortality was 19%, 17.6% and 11.7% in Groups I, II and III respectively (NS), and was not influenced by patients age, number of vessels with critical coronary artery disease and the type of the valve procedure. There was a significant decrease in the release of LDH and AST in Group III when compared with Group II (p less than 0.02 and p less than 0.01) respectively. The linearized rate of recurrence of angina (% per patient year) was 0.4, 0.95 and 0.07; and late mortality (% per 100 years) was 5.8, 3.2 and 2.6 in Groups I, II and III respectively. Patient survival and the quality of life has been improved since the introduction of cold blood cardioplegic protection.