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J Thorac Cardiovasc Surg 1998;115:1298-1302
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Long-term results of mitral-aortic valve operations

From the Clinic for Cardiovascular Surgery, CHUV (Centre Hospitalier Universitaire Vaudois), Lausanne, Switzerland.

Received for publication Oct. 21, 1997. Revisions requested Dec. 8, 1997; revisions received Jan. 9, 1997. Accepted for publication Jan. 9, 1998. Address for reprints: X. Mueller, MD, Department of Cardiovascular Surgery, CHUV, CH-1011 Lausanne, Switzerland.

Abstract

Objective: We analyzed the long-term morbidity and mortality of our experience with combined mitral-aortic surgery, as well as their determinants.
Methods: Among 2109 consecutive patients undergoing valve operations, 200 had mitral-aortic valve procedures with at least implantation of a mechanical prosthesis: 163 of 200 (81.5%) patients had double valve replacement and 37 of 200 (18.5%) had mitral valve repair and aortic valve replacement. All mechanical valves were bileaflet prostheses. Preoperatively, 171 of 200 (85.5%) patients were in New York Heart Association class III-IV. Event-free survivals were determined by means of the Kaplan-Meier method and determinants of survivals with the Cox proportional hazards model (p < 0.05) entering 39 preoperative and perioperative factors. Follow-up was complete for 96% of the patients (192/200).
Results: Overall survivals at 5, 10, and 15 years were 88.5% ± 0.55%, 73.5% ± 4%, and 53.3% ± 8.9%, and rates of freedom from valve-related mortality were 92.9% ± 1.5%, 85.8% ± 3.5%, and 85.8% ± 3.5%. The rates of freedom from permanent valve-related impairment were 91.5% ± 1.7%, 85.4% ± 3.5%, and 79.3% ± 6.7%, and those from all valve-related mortality and morbidity were 74.1% ± 2.3%, 53.8% ± 5%, and 49% ± 5.6%. At last follow-up, 90% (139/154) of the survivors were in New York Heart Association class I-II. Left ventricular ejection fraction less than 50%, age older than 70 years, and preoperative ventricular arrhythmias were independent risk factors for valve-related late deaths. Diabetes, ejection fraction less than 50%, and coronary artery disease were independent determinants of all valve-related events.
Conclusions: Functional results of survivors of combined mitral-aortic surgery are excellent. However long-term valve-related morbidity and mortality are substantial. In the patient population studied, the predictors are determined by patient-related factors, mainly myocardial factors, but not by valve-related factors.

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