The Journal of Thoracic and Cardiovascular Surgery, Vol 75, 865-869, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Aortic valve replacement and aorta-coronary bypass surgery. Results with perfusion of proximal and distal coronary arteries
Q Macmanus, G Grunkemeier, L Lambert, C Dietl and A Starr
The results in 80 patients undergoing simultaneous aortic valve replacement
and aorta-coronary saphenous vein bypass grafting were analyzed to assess
the effect of operative technique. The over-all operative mortality rate of
6.3% (five of 80) did not differ significantly from our results with aortic
valve replacement alone. All patients who had isolated aortic valve
replacement were operated upon with moderate hypothermia. The combined
operation was performed in two ways. Thirty-one patients had aortic valve
replacement prior to bypass grafting with intermittent coronary ostila
perfusion. There were two deaths (6.5%), and five myocardial infarctions
(16.1%) were diagnosed by standard electrocardiographic and enzyme
criteria. More recently, 49 patients have undergone bypass grafting prior
to aortic valve replacement. The proximal ends of the grafts were either
anastomosed high on the aortic root or else individually cannulated to
provide continuous distal perfusion during subsequent aortic valve
replacement, with continuous coronary ostial perfusion. There were three
operative deaths (6.1%) and one myocardial infarction (2.0%). The risk of
combined aortic valve replacement and coronary bypass need be no greater
than the risk of aortic valve replacement alone. Our experience suggests
that myocardial perfusion distal to significant coronary artery stenoses
reduces the risk of myocardial infarction in patients with coronary artery
disease requiring aortic valve replacement.
