Concomitant mitral valve surgery with aortic valve replacement: a 21-year experience with a single mechanical prosthesis

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Abstract Background
Long-term survival for combined aortic and mitral valve replacement appears to be determined by the mitral valve prosthesis from our previous studies. This 21-year retrospective study assess long-term outcome and durability of aortic valve replacement (AVR) with either concomitant mitral valve replacement (MVR) or mitral valve repair (MVrep). We consider only a single mechanical prosthesis.


Three hundred and sixteen patients underwent double valve replacement (DVR) (n = 273) or AVR+MVrep (n = 43), in the period 1977 to 1997. Follow up of 100% was achieved via telephone questionnaire and review of patients' medical records. Actuarial analysis of long-term survival was determined by Kaplan-Meier method. The Cox regression model was used to evaluate potential predictors of mortality.

There were seventeen cases (5.4%) of early mortality and ninety-six cases of late mortality. Fifteen-year survival was similar in both groups at 44% and 57% for DVR and AVR+MVrep respectively. There were no significant differences in valve related deaths, anticoagulation related complications, or prosthetic valve endocarditis between the groups. There were 6 cases of periprosthetic leak in the DVR group. Sex, pre-operative mitral and aortic valve pathology or previous cardiac surgery did not significantly affect outcome.

The mitral valve appears to be the determinant of survival following double valve surgery and survival is not significantly influenced by mitral valve repair.

Replacement of the aortic valve at the time of double valve surgery is not contentious. However, the relative merits of either mitral valve repair or mitral valve replacement in these patients remains to be elucidated. In our previous study over 13 years with the St. Jude Medical (SJM) mechanical prosthesis valve, we observed that long-term survival for combined aortic and mitral valve replacement was similar to that for mitral valve replacement alone [1]. Therefore, we decided to include in present study all patients with a SJM aortic valve replacement (AVR), and concomitant mitral valve repair (MVrep) or mitral valve replacement (MVR) in a 21-year period to determine long-term survival for combined procedures. This study considered only patients in whom the SJM prosthesis was used for valve replacement.

Three hundred and sixteen patients (227 female; 89 male) had AVR with either mitral valve replacement (DVR n = 273) or mitral valve repair (AVR+MVrep n = 43), between January 1977 and December 1997. All prosthetic valves were St. Jude Medical (SJM) mechanical prosthesis (St. Jude Medical, St. Paul. Mn.)


  1. Ibrahim M, O'Kane H, Cleland J, Gladstone D, Sarsam M, Patterson C: The St. Jude medical prosthesis: A 13 year experience. J Thorac Cardiovas Surg 1994, 108:221-230.
  2. Carpentier A: Cardiac valve surgery-the French correction.". J Thorac Cardiovasc Surg 1983, 86:323-337.
  3. Edmunds LH, Clark RE, Cohn LH, Grunkemeier GL, Miller DG, Weisel RD: Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg 1996, 62:932-5.
  4. Hamamoto M, Bando K, Kobayashi J, Tosihiko S, Sasako Y, Niwaya K, Tagusari O, Yagihara T, Kitamura S: Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement. Ann Thorac Surg 2003, 75:28-34.
  5. Gillinov MA, Blackstone EH, Cosgrove DM, White J, Kerr P, Marullo A, McCarthy P, Lytle B: Mitral valve repair with aortic replacement is superior to double valve replacement. J Thorac Cardiovasc Surg 2003, 125:1372-87.
  6. Remadi JP, Baron O, Tribouilly C, Roussel JC, Al_Habasch 0, Despins P, Michaud JL, Duveau D: Bivalvular mechanical mitral-aortic valve replacement in 254 patients: Long-term results ├óÔé¼ÔÇ£ A 22-year follow-up. Ann Thorac Surg 2003, 76:487-92.
  7. Fiore AC, Swartz MT, Sharp TG, Kesler KA, Barner HB, Naunheim KS, Grunkemeier GL, Moroney DA, Kaiser GC: Double-valve replacement with Medtronic-Hall or St. Jude valve. Ann Thorac Surg 1995, 59:1113-9.
  8. Milano A, Guglielmi C, De Carlo M, Di Gregorio O, Borzoni G, Verunelli F, Bortolotti U: Valve-related complications in elderly patients with biological and mechanical aortic valves. Ann Thorac Surg 1998, 66:S82-7.
  9. Birkmeyer NJO, Marrin CAS, Morton JR, Leavitt BJ, Lahey SJ, Charlesworth DC, Hernandez F, Olmstead EM, O'Connor GT: Decreasing mortality for aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 2000, 70:432-7.
  10. Armenti F, Stephenson LW, Edmunds H: Simultaneous implantation of St. Jude Medical aortic and mitral prostheses. J Thorac Cardiovasc Surg 1987, 94:733-9.
  11. Remadi JP, Bizouarn P, Baron O, Al Habash O, Despins P, Michaud J, Duveau D: Mitral valve replacement with the St. Jude medical prosthesis: A 15 year follow-up. Ann Thorac Surg 1998, 66:762-7.
  12. Kawachi Y, Matuzaki K, Tominaga R, Yasui H, Tokunaga K: The risks of re-operation for prosthetic valve dysfunction. Surgery Today 1994, 24:415-9.
  13. Jones JM, O'Kane H, Gladstone DJ, Sarsam MA, Campalani G, MacGowan SW, Cleland J, Cran GW: Repeat heart surgery: Risk factors for operative mortality. J Thorac Cardiovasc Surg 2001, 122:913-8.
  14. The United Kingdom heart valve registry report 2001 Department of cardiothoracic surgery, Imperial College Faculty of Medicine, Hammersmith Hospital. London. United Kingdom.;
  15. Fasol R, Mahdjoobian K, Joubert-Hubner E: Mitral repair in patients with severely calcified annulus: feasibility, surgery and results. J Heart valve Dis 2002, 11:153-9.
  16. Guillinov AM, Cosgrove DM: Mitral valve repair for degenerative disease. J Heart Valve Dis 2002, 11:S15-20.