title: Influence of concomitant CABG and urgent/emergent status on mitral valve replacement surgery.
abstract: BACKGROUND
  Outcomes and resource utilization of patients undergoing mitral valve replacement (MVR) with or without concomitant coronary artery bypass grafting (CABG) were reviewed.
  
  
  METHODS
  Data for 1,844 patients undergoing isolated primary MVR at Emory University Hospitals between 1980 and 1997 were recorded prospectively in a computerized database.
  
  
  RESULTS
  The four groups included patients undergoing elective MVR with (n = 360) or without CABG (n = 1332) and urgent/emergent MVR with (n = 66) or without CABG (n = 86). Length of stay was significantly higher in patients undergoing elective MVR with CABG (15 days) than in those without CABG (11 days) but was not significantly different in patients undergoing urgent/emergent MVR with CABG (17 days) than in those without CABG (19 days). In-hospital mortality was significantly higher for patients undergoing elective (14%) or urgent/emergent (41%) MVR with CABG than in those undergoing MVR without CABG (elective:6%; urgent/emergent:20%). The 19-year survival rate was 32% for patients undergoing elective MVR with CABG compared with 51% for those without CABG and 28% for patients undergoing urgent/emergent MVR with CABG compared with 46% for those without CABG. Multivariate correlates of long-term mortality included older age, concomitant CABG, and urgent/emergent status. Hospital costs were significantly higher for patients undergoing elective MVR with ($33,216) than for those without ($23,890) CABG. No significant difference in cost were noted between patients undergoing urgent/emergent MVR with ($40,535) and without ($31,981) CABG.
  
  
  CONCLUSIONS
  The addition of CABG or urgent/emergent status to patients undergoing MVR significantly increases morbidity, mortality, and costs. Careful scrutiny of the benefits versus resource utilization is required for patients undergoing high risk MVR.
authors.affiliation: Carlyle Fraser Heart Center, Department of Surgery, Emory Center of Outcomes Research, Atlanta, Georgia, USA.
authors.forename: V H
authors.initials: VH
authors.lastname: Thourani
authors.forename: W S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: J M
authors.initials: JM
authors.lastname: Craver
authors.forename: E L
authors.initials: EL
authors.lastname: Jones
authors.forename: J P
authors.initials: JP
authors.lastname: Gott
authors.forename: W M
authors.initials: WM
authors.lastname: Brown
authors.forename: J D
authors.initials: JD
authors.lastname: Puskas
authors.forename: R A
authors.initials: RA
authors.lastname: Guyton
mesh_terms: D001026:Coronary Artery Bypass / Q000191:economics / Q000401:mortality; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D015996:Survival Rate