HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eugene H. Blackstone Delos M. Cosgrove, III Paul Kerr Antonino Marullo Patrick M. McCarthy Bruce W. Lytle Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gillinov, A. M. Articles by Lytle, B. W. Search for Related Content PubMed PubMed Citation Articles by Gillinov, A. M. Articles by Lytle, B. W. Related Collections Valve disease

J Thorac Cardiovasc Surg 2003;125:1372-1387
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Mitral valve repair with aortic valve replacement is superior to double valve replacement

From the Department of Thoracic and Cardiovascular Surgery^a and the Department of Biostatistics and Epidemiology,^b The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication Aug 20, 2002. Revisions requested Aug 28, 2002; revisions received Sept 9, 2002. Accepted for publication Sept 17, 2002. Address for reprints: A. Marc Gillinov, MD, The Cleveland Clinic Foundation, Department of Thoracic and Cardiovascular Surgery/F25, 9500 Euclid Ave, Cleveland, OH 44195. (E-mail: gillinom{at}ccf.org).

Objectives: Double valve replacement has been advocated for patients with combined aortic and mitral valve disease. This study investigated the alternative that, when feasible, mitral valve repair with aortic valve replacement is superior.
Patients and Methods: From 1975 to 1998, 813 patients underwent aortic valve replacement with either mitral valve replacement (n = 518) or mitral valve repair (n = 295). Mitral valve disease was rheumatic in 71% and degenerative in 20%. Mitral valve replacement was more common in patients with severe mitral stenosis (P = .0009), atrial fibrillation (P = .0006), and in patients receiving a mechanical aortic prosthesis (P = .0002). These differences were used for propensity-matched multivariable comparisons. Follow-up extended reliably to 16 years, mean 6.9 ± 5.9 years.
Results: Hospital mortality rate was 5.4% for mitral valve repair and 7.0% for replacement (P = .4). Survivals at 5, 10, and 15 years were 79%, 63%, and 46%, respectively, after mitral valve repair versus 72%, 52%, and 34%, respectively, after replacement (P = .01). Late survival was increased by mitral valve repair rather than replacement (P = .03) in all subsets of patients, including those with severe mitral valve stenosis. After repair of nonrheumatic mitral valves, 5-, 10-, and 15-year freedom from valve replacement was 91%, 88%, and 86%, respectively; in contrast, after repair of rheumatic valves, it was 97%, 89%, and 75% at these intervals.
Conclusions: In patients with double valve disease, aortic valve replacement and mitral valve repair (1) are feasible in many, (2) improve late survival rates, and (3) are the preferred strategy when mitral valve repair is possible.

This article has been cited by other articles:

				Y. G. Peng, T. Martin, T. Horowitz, A. Sidi, and G. Janelle Repair of concomitant valvular endocarditis using a single homograft. Ann. Thorac. Surg., August 1, 2009; 88(2): e14 - e15. [Abstract] [Full Text] [PDF]

				M. Ricci, F. I. B. Macedo, M. R. Suarez, M. Brown, J. Alba, and T. A. Salerno Multiple valve surgery with beating heart technique. Ann. Thorac. Surg., February 1, 2009; 87(2): 527 - 531. [Abstract] [Full Text] [PDF]

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]

				P. W.M. Fedak, P. M. McCarthy, and R. O. Bonow Evolving Concepts and Technologies in Mitral Valve Repair Circulation, February 19, 2008; 117(7): 963 - 974. [Full Text] [PDF]

				S. Talwar, A. Mathur, S. K. Choudhary, R. Singh, and A. S. Kumar Aortic Valve Replacement With Mitral Valve Repair Compared With Combined Aortic and Mitral Valve Replacement Ann. Thorac. Surg., October 1, 2007; 84(4): 1219 - 1225. [Abstract] [Full Text] [PDF]

				M. Nakajima, K. Tsuchiya, Y. Okamoto, and F. Suetsugu Intraoperative saline injection leak test a simple method to assess mitral valve repair when a simultaneous aortotomy does not allow pressurization of the left ventricle Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 580 - 581. [Abstract] [Full Text] [PDF]

				K. Kuwaki, N. Kawaharada, K. Morishita, T. Koyanagi, H. Osawa, T. Maeda, and T. Higami Mitral Valve Repair Versus Replacement in Simultaneous Mitral and Aortic Valve Surgery for Rheumatic Disease Ann. Thorac. Surg., February 1, 2007; 83(2): 558 - 563. [Abstract] [Full Text] [PDF]

				S M Tuladhar and P P Punjabi Surgical reconstruction of the mitral valve Heart, October 1, 2006; 92(10): 1373 - 1377. [Abstract] [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				B. A. Carabello Modern Management of Mitral Stenosis Circulation, July 19, 2005; 112(3): 432 - 437. [Full Text] [PDF]

				H.-Q. T. Ho, V.-P. Nguyen, K.-P. Phan, and N.-V. Pham Mitral Valve Repair with Aortic Valve Replacement in Rheumatic Heart Disease Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 341 - 345. [Abstract] [Full Text] [PDF]