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J Thorac Cardiovasc Surg 2008;136:82-87
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Clinical outcomes of combined aortic root replacement with mitral valve surgery

Division of Cardiovascular Surgery, of Peter Munk Cardiac Centre, Toronto General Hospital, and University of Toronto, Toronto, Ontario, Canada

Received for publication November 4, 2007; revisions received December 26, 2007; accepted for publication February 18, 2008.

^_* Address for reprints: Tirone E. David, MD, 200 Elizabeth St 4N457, Toronto, Ontario M5G 2C4, Canada. (Email: tirone.david{at}uhn.on.ca).

Objective: This study was undertaken to examine the operative mortality and morbidity and late outcomes in patients who required combined aortic root replacement with mitral valve surgery.

Methods: These combined procedures were performed in 123 patients with a mean age of 51 ± 16 years; 67% were men. The aortic root pathology was an aneurysm in 76 patients and other disorders in 47 patients. The mitral valve pathology was degenerative disease in 62 patients and other diseases in 61 patients. Sixty-four patients (52%) underwent previous cardiac surgery. The aortic valve was preserved in 21 patients, and the mitral valve was preserved in 67 patients; the remaining patients underwent valve replacement. In addition, 57 patients underwent other procedures. The mean follow-up was 4.9 ± 4.3 years and complete.

Results: The operative mortality rate was 6.5% (8 patients), and late mortality was 9.7% (12 patients). Reexploration of the mediastinum for bleeding (15%) and implantation of permanent pacemaker (18%) were the most common postoperative complications. Urgent surgery and functional class IV were predictors of operative mortality by univariate analysis. Survival at 1, 5, and 10 years was 90.9% ± 2.6%, 86.1% ± 3.3%, and 79.3 ± 4.9%, respectively. Six patients required reoperation. Freedom from reoperation at 1, 5, and 10 years was 100%, 96.4% ± 2.5%, and 85.7% ± 6.4%, respectively. At the latest follow-up, 98 patients were alive and free from reoperation; 92 patients were in functional classes 1 and 2, and 88 patients were free from any cardiac or valve-related complication.

Conclusion: Aortic root replacement combined with mitral valve surgery is a complex operation associated with high morbidity, but the operative mortality is reasonably low and the long-term outcomes are gratifying.