Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement

Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
The Annals of Thoracic Surgery (Impact Factor: 3.85). 02/2003; 75(1):28-33; discussion 33-4. DOI: 10.1016/S0003-4975(02)04405-3
Source: PubMed


The purpose of this study was to evaluate morbidity and mortality after double valve replacement (DVR) and aortic valve replacement with mitral valve repair (AVR + MVP).
From 1977 to 2000, 379 patients underwent DVR (n = 299) or AVR + MVP (n = 80). Actuarial survival and freedom from reoperation were determined by the Kaplan-Meier method. Potential predictors of mortality and reoperation were entered into a Cox multiple regression model. Propensity score was introduced for the multivariable regression modeling for adjustment of a selection bias.
Survival 15 years after surgery was similar between the groups (DVR, 81% +/- 3%; AVR + MVP, 79% +/- 7%; p = 0.44). Freedom from thromboembolic event at 15 years was similar between the groups (p = 0.25). Freedom from mitral valve reoperation at 15 years was significantly better for the DVR group (54% +/- 5%) as compared with the AVR + MVP group (15% +/- 6%; p = 0.0006), primarily due to progression of mitral valve pathology and early structural deterioration of bioprosthetic aortic valve used for patients with AVR + MVP. After AVR + MVP, freedom from mitral reoperation at 15 years was 63% +/- 16% for nonrheumatic heart diseases, and 5% +/- 5% for rheumatic disease (p = 0.04).
Although both DVR and AVR + MVP provided excellent survival, DVR with mechanical valves should be the procedure of choice for the majority of patients because of lower incidence of valve failure and similar rate of thromboembolic complications compared with AVR + MVP. MVP should not be performed in patients with rheumatic disease because of higher incidence of late failure.

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    • "Our results are similar to those obtained by Leavitt et al. [15], and different from those of Gillinov et al. and Kim et al. [11] [12], both of whom report that MVP had improved long-term survival compared with MVR. Finally, other authors [9] [10] [13] [14] conclude that MVR provides greater long-term survival than MVP. These conflicting results can be probably explained by heterogeneity in the patients' demographic profiles, the lack of data related to the aetiology of MV disease and the different types of mitral repair used. "
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    ABSTRACT: Objectives: There are limited reliable data on the long-term survival of patients operated upon with double-valve surgery (DVS) in the literature. In this study, in-hospital mortality and 5-year survival were determined and the potential risk factors for increased mortality were identified and discussed. Methods: This is a report of an observational retrospective study of 1167 patients undergoing concomitant aortic and mitral valve surgery from 2002 to 2011. Data were prospectively collected in a regional database from Emilia-Romagna (Italy). Results: The overall in-hospital mortality rate for DVS was 6.9%. Both in-hospital and 1-year mortality were statistically significant between age groups. In-hospital mortality was significantly higher for patients with a smaller body mass index (BMI), for those who had concomitant coronary artery bypass grafting (CABG) and those who received mitral valve replacement (MVR) instead of plasty (MVP). In-hospital and 1-year mortality were highest in patients ≥70 who had implantation of mitral and aortic mechanical valves. There were significant differences in 5-year follow-up survival according to age, BMI and concomitant CABG. The choice of MVR and MVP did not affect 5-year survival. Multivariable analysis showed that patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation or other intraoperative variables. Conclusions: Advanced age, smaller BMI and concomitant CABG are significant risk factors for mortality in DVS. MVP provided comparable 5-year outcomes with MVR. Multivariable analysis demonstrates that preoperative and clinical patient-related factors are the real burden in the successful treatment of patients undergoing double-valve procedures.
    Interactive Cardiovascular and Thoracic Surgery 07/2014; 19(5). DOI:10.1093/icvts/ivu248 · 1.16 Impact Factor
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    • "The decision to perform either DVR or AVR+MVrep was dependent on the operating surgeon and thus indications naturally varied according to surgical experience. The absolute numbers of patients were relatively small, but these are at least comparable to recently reported series [4-6]. "
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    ABSTRACT: 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.
    Journal of Cardiothoracic Surgery 02/2007; 2(1):24. DOI:10.1186/1749-8090-2-24 · 1.03 Impact Factor
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    ABSTRACT: A descriptive and cross-sectional study was carried out on 107 patients to whom plurivalvular substitutions were carried out in Santiago de Cuba Cardiology Center during the period between January, 2003 to December, 2008. A marked functional prevalence of surgically treated people in middle ages of life with advanced classes, and preoperative diagnosis of mitral valve and aortic disease was found, as well as that the substitution of these valves by mechanical prostheses was the most used surgical intervention in the case material. Either the peroperative or postoperative complications were uncommon and, in consequence, 2 of the members of the series died, for a surgical mortality of 1,9% that, when being compared with the informed mortality by other authors, it has been considered low.
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