[Cardiac valve replacement and simultaneous myocardial revascularization].

Between 1974 and 1981, 84 patients underwent cardiac valve replacement and simultaneous myocardial revascularization. 77 patients had rheumatic valve disease with coexisting coronary artery disease (group I). Single valve replacement was performed in 67 patients, double valve replacement in 9 patients, and triple valve replacement in 1 patient. A second group consisted of 7 patients with severe coronary artery disease: in 6 of them papillary muscle necrosis necessitated mitral valve replacement, and in 1 patient hemodynamic reasons made aortic valve replacement necessary. The mean number of coronary artery bypass grafts performed was 1.7 in group I and 2.4 in group II. 56 patients were classified as NYHA grade III, 28 as grade IV. 8 patients (9.4%) died within 32 days after operation (7 from group I, 1 from group II). Follow-up averaged 20 months. There were 3 late deaths; 35 of the survivors underwent clinical reexamination, and all 73 completed questionnaires. Symptomatic improvement was found to be excellent: 97% of the patients examined had improved at least by one functional class. It is our impression that simultaneously performed myocardial revascularization does not substantially increase the risk of cardiac valve replacement, and yields good late results.