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

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Abstract

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.

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Methods
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.

Results
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.

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

Background
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.

Methods
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.)

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References
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