Early and midterm results of patients above or below 65-year-old undergoing coronary artery bypass grafting combined with valve replacement

Objective 　To retrospectively analyze the early and midterm outcomes and summarize experiences of coronary artery bypass grafting (CABG) combined with valve replacement (VR) in patients below or above 65-year-old. Methods 　The clinical data of 110 patients, who received valve replacement combined with CABG in the General Hospital of PLA from Apr. 1998 to May 2012, were analyzed retrospectively. The patients were divided into two groups according to their age of ≥65 years (39 cases) or <65 years (71 cases). The preoperative incidence of chronic obstructive pulmonary diseases (COPD) was higher in ≥65 years group than in <65 years group (P<0.05). No significant difference was found between the two groups in other preoperative complications such as cerebrovascular disease, diabetes mellitus, HBP, renal inadequacy and valve disease. All the operations were performed under general anesthesia and cardiopulmonary bypass (CPB), including CABG combined with mitral valve replacement (59 cases), aortic valve replacement (35 cases), and double valve-replacement (16 cases). Tissue valve was applied to the patients aged over 60 years. Among the CABG, 55, 38, 13 and 3 patients were transplanted with 1, 2, 3 and 4 grafts, respectively, only one patient receive 5 grafts transplantation. The mean grafts number was 2.1±0.4. The mammary artery and/or saphenous vein were used as graft materials. Results 　No significant difference existed between the two groups in mortality and incidence of complications including renal failure, perioperative myocardial infarction, bleeding/pericardial tamponade, pleural effusion and stroke (P>0.05), neither in the mechanical ventilation time, the intensive care time, application of intra-aortic balloon counter pulsation (IABCP), the postoperative hospitalization time, CPB time and cross-clamping time. The patients of ≥65 years were followed up from 2 months to 11 years after surgery, of whom 3 patients were lost to follow-up. One patient died of severe drug eruption in 2 months, another one died of lung cancer 2 years later, 2 patients suffered from cerebral infarction, and the life quality in other patients improved obviously with cardiac function evaluated in class I or Ⅱ. The patients in <65 years group were followed up by 3 months to 12 years. Of whom 8 patients lost the follow-up, two patients who received mechanic valve replacement got complications related to anticoagulation treatment in 3 and 6 years after surgery. One of the two died of severe low cardiac output. Conclusion 　The early and mid-term outcomes of CABG combined with valv