Risk Factors and Complications Structure in Patients After Surgical Treatment of Combined Aortic and Mitral Valve Disease with Concomitant Coronary Artery Disease

Abstract

Introduction. Combined aortic and mitral valve lesions on the background of coronary artery disease require complex surgical correction and are associated with high perioperative risk and frequent complications. Local data on such interventions remain limited.

Aim. To determine the structure of complications following combined aortic and mitral valve replacement with concomitant coronary artery bypass grafting (AVR+MVR+CABG).

Materials and Methods. A retrospective single-center study included 57 patients operated in 2018-2023. Clinical, laboratory, and echocardiographic parameters were analyzed; operative risk was assessed using EuroSCORE II and STS models. Intra- and postoperative parameters were recorded; complications were classified as acute kidney injury (AKI, KDIGO), bleeding (BARC≥3), infectious, neurological, cardiac, pericarditis, rethoracotomy, and in-hospital mortality. Uni- and multivariate logistic regression was used to identify predictors of the composite endpoint (mortality / major complications) with ORs and 95 % CI (p<0.05).

Results and discussion. Patients were high-risk: EuroSCORE II Me 7.0 % [4.3-10.9], STS mortality 12.2 % [8.7-17.3], STS mortality/morbidity 61.3 % [49.9-69.0]. In-hospital mortality was 10.5 % (6/57). The main causes of death were acute kidney injury progressing to multiorgan failure (n=2), acute cerebrovascular accident (n=1), pneumonia with septic shock (n=1), mediastinitis with sepsis (n=1), and acute graft thrombosis resulting in myocardial infarction (n=1). Major postoperative complications included: AKI 38.0 % (dialysis-dependent 15.8 %), infectious complications 47.4 % (mediastinitis 7.0 %), neurological disorders 43.9 % (delirium/encephalopathy), stroke 7.0 %, rethoracotomy for bleeding 12.3 %, and pericarditis 10.5 %. Typical hyperlactatemia peaked at 6 hours and normalized within 48 hours. Postoperative valve gradients remained within expected ranges; left ventricular ejection fraction at discharge was Me 50 % [41-56]. Preventive priorities include KDIGO-based AKI prevention, neuroprotection and delirium/stroke prevention strategies, strengthened infection control, blood conservation programs, and refined perioperative risk stratification.

Conclusions.

1. The combined valve–coronary cohort demonstrated high surgical risk, with elevated EuroSCORE II and STS indices and hospital mortality of 10.5 %. Functional results were satisfactory: prosthetic valve gradients remained within expected limits, and LVEF at discharge (Me 50 % [41-56]) indicated stable systolic performance.
2. The postoperative course was dominated by an organ-dysfunction–driven complication structure, including renal complications (AKI 38.0 %, dialysis-dependent 15.8 %), infectious events (47.4 %, mediastinitis 7 %), neurological disorders (delirium/encephalopathy 43.9 %, stroke 7 %), and additional cardiac/bleeding complications (re-thoracotomy 12.3 %, pericarditis 10.5 %).
3. The findings support the need for standardized perioperative pathways, emphasizing KDIGO-based renal protection, neuroprotection, infection control, and blood-conservation strategies, with combined EuroSCORE II+STS use for precise risk stratification.