Outcomes of mitral valve surgery during concomitant aortic valve replacement

Abstract

Background This study evaluates outcomes of mitral valve surgery (MVS), replacement (MVR), and repair (MVr), during concomitant aortic valve replacement (AVR). Methods Patients undergoing MVS with concomitant AVR between 2011 and 2017 at a single center were reviewed. Patients were stratified into MVR versus MVr with concomitant AVR. Outcomes included early and midterm mortality, hospital re‐admissions, re‐operations, and complications. Multivariable Cox regression analysis was used for risk‐adjustment. Results Four hundred twenty‐four patients underwent MVS with concomitant AVR: 247 (58.3%) MVr and 177 (41.7%) MVR. In unadjusted analysis, there was a non‐significant increase in 30‐day mortality with MVR, with no differences in 1‐ and 5‐year mortality (30‐day: 5.6% vs 10.1%, P = 0.081; 1‐year: 14% vs 18.2%, P = 0.181; 5‐year: 35.1% vs 37.8%, P = 0.232). Freedom from re‐admission and mitral reoperation were comparable. Freedom from at least moderate mitral regurgitation at 5 years was 78% in MVr patients. Those undergoing MVR had increased postoperative blood transfusions, acute renal failure, and pleural effusions requiring drainage (P each <0.05). Conclusions MVr can be performed during concomitant AVR without an adverse impact on longer‐term outcomes, including mortality, re‐admissions, and mitral reoperations. The majority of patients have durable repairs at 5 years although durability is less than that reported in isolated MVS.

Survival and long-term outcomes after concomitant mitral and aortic valve replacement in patients with rheumatic heart disease

“…In their study population, 15.8% (aortic) to 37.5% (mitral) patients had rheumatic aetiology. Majority (53 to 57%) of the patients had degenerative valve disease, and the mean age was 68.8 ± 11.8 years [ 14 ]. In our study, we included only patients with RHD who usually present earlier, and this is reflected in the lower mean age of patients in our study population (Table 6 ).…”

“…Indian J Thorac Cardiovasc Surg (January-February 2021) 37(1):[5][6][7][8][9][10][11][12][13][14][15] …”

Long-Term Performance of Mechanical and Biological Prostheses in Young Rheumatics aged below 45 years undergoing Combined Mitral and Aortic Valve Replacements: A Propensity-Matched Study

“…[37,38] Similar findings have been noted by other investigators. [56][57][58][59][60][61] The low in-hospital mortality observed in the study can be attributed to uniform myocardial preservation strategy, preservation of chordopapillary apparatus, implantation of appropriate sized low-profile prostheses, and performing aortic root enlargement procedures in cases of small aortic root, thus avoiding patient -prosthesis mismatch and atrioventricular groove disruption. 62,63 Timely intraoperative and perioperative institution of intraaortic balloon counterpulsation in selected individuals undergoing combined mitral-aortic valve replacement with low cardiac output syndrome have further improved our surgical results.…”