Incidence and implications of coronary artery disease in patients undergoing valvular heart surgery: The Indian scenario

• Main Authors: Deepak K Tempe, Sanjula Virmani, Rupak Gupta, Vishnu Datt, Chandrashekhar Joshi, Aastha Dhingra, Rahul Dutta, Harpreet Singh Minhas
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2013-01-01
• Series: Annals of Cardiac Anaesthesia
• Subjects: Cardiac surgery; Coronary artery bypass grafting; Coronary artery disease; Valve surgery
• Online Access: http://www.annals.in/article.asp?issn=0971-9784;year=2013;volume=16;issue=2;spage=86;epage=91;aulast=Tempe

Aims and Objectives: We evaluated the incidence and implications of coronary artery disease (CAD) in patients above 40 years presenting for valve surgery. Materials and Methods: Between January 2009 and December 2010, coronary angiography (CAG) was performed in all such patients ( n = 140). Results: Coronaries were normal in 119 (Group I), and diseased in 21 (Group II). In Group II, 11 patients were < 50 years, 3 were between 51 and 60 years and 7 were > 61 years. In 8 of these, only valve replacement was performed. Coronary artery bypass grafting (CABG) and aortic valve replacement was performed in 10, CABG and mitral valve replacement in 2 and CABG with mitral and aortic valve replacement in one. The number of vessels grafted in these 13 patients was 1.54 ± 0.66. Hypertension and diabetes were significant ( P < 0.05) in this group. The mortality was significant in Group II (11 vs. 6, P < 0.05). Six patients died in Group II, 5 had severe aortic stenosis and severe left ventricular hypertrophy; the sixth patient had severe mitral stenosis and was in CHF. The predominant cause of death was congestive heart failure (CHF). Conclusions: Fifteen percentage of these patients had CAD. CAG should be performed routinely in these patients while presenting for valve surgery. Combined CABG and valve replacement carries high mortality (28.5%), especially in patients with aortic stenosis. The study suggests that the cardio-protective measures should be applied more rigorously in this subset of patients.