Combined Mitral and Aortic Valve Surgery: 17-year Experience in a Single Center

Abstract

Background and Aims: It is not uncommon that patients requiring valve surgery have several simultaneous valvular dysfunctions. Combined aortic and mitral valve surgery is the most common form of double-valve surgery. The aim of this study was to analyze and present the outcomes of simultaneous aortic and mitral valve surgery in a single center in a real-life setting. Materials and Methods: The study population consisted of 150 patients operated in the Kuopio University Hospital from 2004 to 2020. All patients undergoing concomitant mitral and aortic valve surgery were included. Four groups were formed based on either the etiology or pathophysiology of the valvular dysfunction. The most common combination was mitral regurgitation with aortic regurgitation ( n = 72, 48%), followed by mitral regurgitation with aortic stenosis ( n = 37, 25%), endocarditis ( n = 29, 19%), and mitral stenosis with aortic regurgitation or stenosis ( n = 12, 8%). Concomitant coronary artery revascularization was performed in 37 (25%) patients and tricuspid valve repair in 26 (17%) patients. Results: Operative mortality was 2% and 30-day mortality was 7%. Overall survival was 86%, 78%, and 61% in 3, 5, and 10 years, respectively. Patients with endocarditis were significantly more morbid, and more often than other patients had to undergo an emergency operation. There were no significant differences between the groups in terms of early and late survival. In the overall cohort, the EuroSCORE II value, increased pulmonary artery pressure, decreased glomerular filtration, and length of the operation displayed a negative correlation with survival. Conclusion: Despite the challenging nature of multivalvular heart disease, surgery is a safe method of treatment with good short- and long-term outcomes.

Transcatheter mitral valve implantation using the Tendyne valve in a patient with prior transcatheter aortic valve implantation: a case report

“… 1 Surgical intervention has been shown to improve survival significantly in symptomatic patients with multi-valvular disease. 2 The presence of aortic and mitral disease in a patient who is not a suitable candidate for surgical correction poses significant challenges in the diagnostic workup as well as management plans. The combination of aortic stenosis and mitral regurgitation (MR) is not uncommon.…”

“… 1 The presence of significant aortic stenosis results in high mitral regurgitant volume at any given regurgitant orifice area because of an increased transmitral systolic gradient. 2 If the patient is not a candidate for double valve correction, then percutaneous treatment can be staged to fix the aortic valve with transcatheter aortic valve implantation (TAVI) as a first step, followed by a reassessment and percutaneous correction of MR. The feasibility and clinical outcomes of transcatheter mitral valve implantation (TMVI) in patients who already had aortic valve prostheses are not well established.…”

Transcatheter Aortic Valve Replacement as a bridge to minimally invasive endoscopic mitral valve surgery in Elderly Patients in the era of ERAS and Fast Track TAVI concepts

“…No case in our cohort required more than 72 min. Prolonged CBP time especially over 180 min directly correlates with mortality even after adjusting for EuroSCORE II, postoperative complications, prolonged ICU stay, and prolonged mechanical ventilation [18].…”