100 QUESTIONS IN CARDIOLOGY

33 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?

Tom Treasure

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 hemiplegiaare rare with a

combined risk of about 0.5% in current practice. If every focal

deficit discovered on brain imaging, or every transient neurological