Background: Advances in surgical techniques and anesthetic management have decreased the operative mortality for CABG to less than 5% but the risk for valvular surgery remains between 5-12% (5). Identification of high risk patients may permit cardiologists and surgeons to develop strategies to improve results. This is a retrospective cohort study which aims to identify the determinants of in hospital mortality and morbidity after multiple-valve surgery among patients at the Philippine Heart Center.
Methods and Results: Data were collected from 122 patients who underwent Multiple-valve surgery from January 2002 to December 2004. Four significant factors by univariate analysis w re determined: 1) SPAP > 60 mm Hg 2) previous cardiac surgery 3) renal failure 4) congestive heart failure. However, by multivariate analysis, they were not statistically significant probably due to small sample size. But SPAP has a tendency to be significant with a p value of 0.086. Age, sex, NYHA FC, timing of surgery, type and number of valve surgery, LVED, and ejection fraction were not statistically significant predictors of mortality. Bleeding and massive pericardial effusion were significant factors of morbidity post-operatively.
Conclusion: Four variables were identified as significant preoperative risk factors, of which SPAP > 60 mm Hg is the strongest. Thus one of the strategies to improve patient survival is earlier surgical intervention before pulmonary hypertension sets in. Improved techniques of valve repair or replacement and better management of post-operative ventricular dysfunction may also improve the results in these high risk patients.