30. LONG-TERM SURVIVAL AND RESOURCE UTILIZATION OF 1,844 PATIENTS UNDERGOING MITRAL VALVE REPLACEMENT: EFFECTS OF CONCOMITANT CORONARY BYPASS SURGERY AND URGENT/EMERGENT OPERATIONS
Vinod H. Thourani, William S. Weintraub, Joseph M. Craver*, Ellis L. Jones*, John Parker Gott*, W. Morris Brown, John D. Puskas, and Robert A. Guyton*
Emory University
Atlanta, Georgia, USA
OBJECTIVE
To evaluate outcomes and resource utilization of 1,844 patients (pts) undergoing mitral valve replacement (MVR) alone or with concomitant coronary artery bypass grafting (MVR/CABG) either electively or urgently/emergently (U/E).
MATERIAL AND METHODS
From January 1980 to December 1997, pts undergoing MVR were subdivided into: (1) MVR (elective, n=1,332), 2) MVR (U/E, n=86), (3) MVR/CABG (elective, n=360), and (4) MVR/CABG (U/E, n=66).
RESULTS
MVR/CABG pts, compared to MVR pts, were significantly older (elective:65
± 9, U/E:64± 11 vs elective: 55± 14, U/E:54± 15), were more likely to be males (elective:53%, U/E:62% vs elective:36%, U/E:38%), and had a higher history of HTN (elective:53%, U/E:55% vs elective:24%, U/E:21%), Class III-IV angina (elective:51%, U/E:75% vs elective:18%, U/E:26%) and prior MI (elective:35%, U/E:71% vs elective:7%, U/E:22%). Congestive heart failure was similar among groups (MVR/CABG: elective:62%, U/E:59% vs MVR: elective:63%, U/E:79%, P=0.07). Postoperative morbidity and mortality are included in the Table.|
|
MVR (elective) |
MVR (U/E) |
MVR/CABG (elective) |
MVR/CABG (U/E) |
P Value |
|
Q wave MI |
5 (0.4%) |
0 (0%) |
6 (1.7%) |
0 (0%) |
0.03 |
|
Stroke |
45 (3.4%) |
9 (11.3%) |
30 (8.4%) |
6 (9.4%) |
<0.0001 |
|
LOS (days) |
11 ± 9 |
19 ± 24 |
15 ± 14 |
16 ± 18 |
<0.0001 |
|
Hospital Death |
77 (5.9%) |
16 (20%) |
50 (14.0%) |
26 (40.6%) |
<0.0001 |
|
Hospital cost ($) |
23,980 ± 12,339 |
31,981 ± 14,170 |
33,216 ± 24,132 |
40,535 ± 32,465 |
<0.0001 |
|
10-year Survival |
0.51 |
0.46 |
0.32 |
0.28 |
<0.0001 |
CONCLUSION
The performance of MVR urgently/emergently significantly increases morbidity, mortality and costs compared to elective MVR. Patients undergoing concomitant CABG with elective or urgent/emergent MVR have increased morbidity, mortality, and costs compared to MVR. Careful preoperative scrutiny of the benefit vs resource utilization is required for pts undergoing CABG/MVR or urgent/emergent MVR.
