Concomitant mitral valve surgery with aortic valve replacement: a 21-year experience with a single mechanical prosthesis

McGonigle, Niall; Jones, J. B.; Sidhu, Pushpinder; MacGowan, Simon W.

doi:10.1186/1749-8090-2-24

Cited by 15 publications

(12 citation statements)

References 14 publications

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“…Generally speaking, the mortality of double valve replacement is higher than for single valve procedure: 8% in a large series of 343 patients [47], 5% in another series of 316 double valve procedures, including 14% of patients with aortic valve replacement and mitral valve repair [48]. Among patients with surgically treated endocarditis, double valve replacement also carries a lower survival rate than single valve procedure.…”

Section: Prognosis Of Multivalvular Iementioning

confidence: 98%

Clinical and Microbiologic Features of Multivalvular Endocarditis

Selton-Suty

Doco‐Lecompte

Bernard

et al. 2010

Curr Infect Dis Rep

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Multivalvular endocarditis accounts for 15% of all endocarditis. The mechanisms of spread of the infection differs whether endocarditis is only left-sided (involving both the mitral and aortic valves) or bilateral. In left-sided bivalvular endocarditis, it is often a secondary mitral lesion following a primary aortic endocarditis. Multivalvular endocarditis often results in severe and extensive cardiac lesions, well described at echocardiography and frequently responsible for severe heart failure. Patients often need surgery, which consists of radical debridement of all the infected tissue with reconstruction using different types of prostheses; therefore, the surgery may be very complex. The goal should be an early diagnosis of endocarditis to avoid spread of the infection to more than one valve, to improve the prognosis for those patients.

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Section: Prognosis Of Multivalvular Iementioning

confidence: 98%

Clinical and Microbiologic Features of Multivalvular Endocarditis

Selton-Suty

Doco‐Lecompte

Bernard

et al. 2010

Curr Infect Dis Rep

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“…For patients with aortic and mitral valve disease, although several studies have been conducted to compare the clinical outcomes of double valve replacement (DVR) and aortic valve replacement plus mitral valve repair (AVR plus Mitral valve [MV]r) [1][2][3][4][5][6][7], there still remains controversy as to which strategy is superior [8].…”

Section: Introductionmentioning

confidence: 99%

Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement

Kim

Han

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: Whether to repair or replace the mitral valve for patients with significant mitral regurgitation undergoing aortic valve replacement is still controversial. METHODS:From January 1990 to December 2011, a total of 663 patients underwent aortic valve replacement combined with mitral valve surgery. Among these, 253 patients (mean age 55.9 ± 14.5 years, 91 females) with moderate-to-severe mitral regurgitation were enrolled to compare the outcomes between double valve replacement (DVR group, n = 158) and aortic valve replacement plus mitral valve repair (AVR plus MVr group, n = 95). Survival and valve-related events were compared by the inverse-probability-treatment-weighted method using propensity scores to reduce treatment selection bias. RESULTS:Early mortality was similar between the groups (1.9% in the DVR group when compared with 3.2% in the AVR plus MVr group, P = 0.55). During the mean follow-up period of 72.1 ± 56.7 months, 45 patients died (28 in DVR and 17 in AVR plus MVr) and 31 experienced valve-related events including valve reoperation in 11, anticoagulation-related bleeding in 14, thromboembolism complications in 9 and infective endocarditis in 3. After adjustment for baseline risk profiles, the DVR group showed no difference with regard to risks of death (hazard ratio [HR], 1.79; 95% confidence interval [CI], 0.79-4.01; P = 0.16) and valve-related events (HR, 1.15; 95% CI, 0.40-3.30; P = 0.80) compared with the AVR plus MVr group. CONCLUSIONS:Although the outcomes of either mitral valve repair or replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement show no statistical significance in terms of long-term survival and valve-related event rates, DVR seems more hazardous than AVR plus MVr based on the estimated HR in terms of survival.

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“…Still, currently, patients with PVE, who have more than one prosthetic valve, are deemed bad surgical candidates and surgery is not undertaken even when it could be indicated [7]. Remarkably, in a recent report, all nine patients with PVE and double prostheses were treated medically and only one survived [11].…”

Section: Discussionmentioning

confidence: 96%