What is the risk of a patient dying or having a myocardial infarction around the time of surgery for coronary artery disease and for valve replacem

What is the risk of a patient dying or having a myocardial infarction around the time of surgery for coronary artery disease and for valve replacement?

General approach to quoting numbers
First some general comments. The figures given should ideally be those currently being achieved by the team to whom the patient is referred. In general terms, registry data are more representative than published series, which inevitably include bias towards more successful figures. The data should be adjusted up or down to match the circumstances of the individual patient, who is helped towards a rational decision based on the anticipated risks and benefits.

What is the risk of death with CABG
The UK Cardiac Surgery Register for the three years up to 1997 gives a 3% mortality for isolated coronary artery surgery, which is applicable to the current case mix. It therefore applies to the typical patients – male, elective, aged 60–70, with an adequate left ventricle. Patients with one or more risk factors for perioperative death, which are older age, female sex, obesity, worse ventricular function, diabetes, very unstable or emergency status, or significant co-morbidity of any type, should have the stated risk
appropriately increased.

What is the risk of death with valve replacement?
The United Kingdom Heart Valve Registry provides very reliable thirty day mortality figures which for the three years 1994–1996 inclusive were 5% for aortic valve replacement and 6% for mitral valve replacement.

What is the risk of stroke?
Lethal brain damage and permanently disabling hemiplegia are rare with a combined risk of about 0.5% in current practice. If every focal deficit discovered on brain imaging, or every transient neurological sign is included the incidence would probably be nearer 5%. Most of these focal deficits are caused by atheroembolism. Air, left atrial thrombus and calcific valve debris are additional risk in valve surgery. I quote the routine patient a risk of stroke of 1% to 2% adjusted upwards for increasing age, history of previous stroke or TIA, and hypertension, and adjusted down for relative youth. The incidence of subtle diffuse or global brain injury depends on definition. Some difficulty with concentration and memory affects about a quarter of patients – but very few are troubled by it to any extent.

What is the risk of myocardial infarction?
This is extremely difficult to define. In good hands it rarely complicates valve operations without coronary artery disease. In coronary surgery incidence depends on definition but myocardial dysfunction, local or global, is the commonest cause of death. The incidence of infarction is entirely dependant on definition and any figure from 2% to 10% could be given, depending on the criteria used.