الفهرس 
Anatomical ConsiderationsOnly 14 pages are availabe for public view
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Abstract
Operative outcome and follow-up of combined valve surgery and CABG are comparable to that of most literatures studying adult cardiac surgery, and we can see from the previously discussed results that operative, early postoperative and follow-up of patients with combined CABG and valve surgery were excellent in most experiences.
We conclude that, the performance of valve replacement in combination with coronary artery bypass grafting, with the improvement of surgical technique and myocardial protection protocols, became easier, safer and give better results with declining incidence of morbidity and mortality. However, the current study confirms that, patients who undergo combined mitral valve replacement and CABG face a higher risk than those undergoing aortic valve replacement in combination with CABG.
The early risk, functional results, and long-term survival of patients who had combined aortic valve replacement and myocardial revascularization, in most series, are similar to those for patients with isolated aortic valve disease undergoing valve replacement. Since bypass grafting will enhance survival in such patients, we believe that combined aortic valve replacement and total myocardial revascularization should be performed in all patients in whom these lesions co-exist.
Risk factors for combined coronary artery bypass grafting and valve surgery are nearly similar as for either procedure alone, and the added risk of combined lesion is mostly due to the poorer left ventricular function and the more advanced age of patients with combined valve and coronary artery disease.
We found that female sex is an independent risk factor for increased morbidity and mortality for combined CABG and valve surgery, but it is not clear whether this increased risk is due to sex-related differences in the biology of the disease or in gender related issues of treatment and access to care.
In summary, we conclude that patient-related conditions (old age and female sex), cardiac conditions (advanced NYHA functional class, impaired left ventricular function, mitral valve disease, and non-sinus rhythm) and the operative condition of myocardial ischemic time are the most important predictors of clinical outcome after combined valve operation and CABG.
We recommend that, the performance of valve surgery and coronary artery bypass grafting for patients with combined lesion should be done simultaneously because ignoring valve dysfunction at the time of coronary artery bypass grafting and vice versa will limit the potential functional benefit to be attained from operation and compound the patient’s poor life expectancy