Primary triple valve surgery for advanced rheumatic heart disease in Mainland China: a single-center experience with 871 clinical cases

Abstract

Background: Triple valve surgery (TVS) is still of choice for advanced rheumatic heart disease (RHD), which has been associated with reported poor early and late outcomes. We describe the short-and long-term results after TVS in last two decades in Mainland China. Methods: From January 1985 to January 2005, a total of 871 patients (217 men, 654 women), with mean age of 42 AE 11 years, underwent primary TVS for isolated advanced RHD. All patients received replacement procedures in mitral and aortic position (845 mechanical, 26 bioprosthetic), and 840 patients received repair procedures and the other 31 received replacement procedures in tricuspid position (9 mechanical, 22 bioprosthetic). Preoperative, perioperative, and postoperative data were retrospectively analyzed and risk factors affecting early and late survival were evaluated. Results: The 30-day hospital mortality was 8% (n = 71). Presence of ascites, New York Heart Association (NYHA) class IV and lower left ventricular ejection fraction (LVEF) were identified as independent risk factors for hospital mortality. Overall long-term survival rate was 71% AE 3% at 5 years, and 59% AE 5% at 10 years. The cardiac survival rate was 75% AE 3% at 5 years and 63% AE 4% at 10 years. The event-free survival rate at 5 years and 10 years was 61% AE 6% and 41% AE 13%, respectively. Multivariate analysis revealed advanced age, NYHA class IV and lower LVEF were associated with increased late mortality. The freedom from thromboembolism and anticoagulation-related hemorrhage at 10 years was 90% AE 4% and 81% AE 5%, respectively. Of the 508 patients still alive, 376 (74%) were in NYHA class I and II. Conclusions: Primary TVS for advanced RHD appears to offer satisfactory short-and long-term results with excellent symptomatic improvement. Cardiac-related late mortality following TVS may be improved by early surgical treatment before NYHA class IV or deterioration of LVEF occurs. #

Combined Mitral and Tricuspid Valve Repair in Rheumatic Valve Disease

“…Open mitral commissurotomy is a surgical technique with consistently proven efficacy. 8,10 The implantation of a prosthetic ring is indicated in patients with concomitant mitral regurgitation grade 3 or greater or when a residual regurgitation is observed after commissurotomy. In case of confirmation that prosthetic ring annuloplasty associated with open mitral commissurotomy substantially improves the long-term outcome, percutaneous mitral valvuloplasty may be a suboptimal treatment.…”

Long-Term Clinical Outcomes of the Carpentier-Edwards Perimount Pericardial Bioprosthesis in Chinese Patients with Single or Multiple Valve Replacement in Aortic, Mitral, or Tricuspid Positions

“…In addition, age has been reported as an influential factor for bioprosthesis durability, survival, and the risks that are associated with reoperation [1,3,9]. In China, mechanical prostheses are still predominant for cardiac valve replacements in clinical practice; in fact, the patients' age at the time of implantation is relatively younger than in industrialized societies [10,11,12]. Unlike in Western countries, where the etiologic spectrum is dominated by degenerative heart disease, the majority of Chinese patients receive valve replacement as a result of rheumatic heart disease [10,11].…”

Rheumatic mitral valve surgery: about 1025 cases

“…3,13 Against this, in the series of Han and Davoodi. 6,12 there was a predominance of aortic failure: 54% and 84% of cases, respectively (Table 3). In present study, the intervention was a primary type of intervention in 93.2% of cases, a reoperation response in 5.8% of cases, three surgeries in 0.8% of cases, and four in 0.2% of cases.…”

“…Aortic valve replacement is the rule in most series. 12 Aortic plasty has been reported between 2% and 8%. 3,6,13 In our sample, we see a massive use of small size prostheses, which reflect the closeness of the native aortic rings.…”

“…3,7,11 In contrast, Davoodi found a prevalence of deficiencies in mitral (74% of cases), while Han reported a majority of mitral narrowing (58% of cases). 6,12 Moreover, in the series of Alsoufi, patients were distributed evenly between sickness, failure, and mitral stenosis ( Table 2). 13 Regarding the aortic valve, we found a prevalence of aortic diseases (54.9%).…”