Long-term results after concomitant mitral and aortic valve surgery: repair or replacement?†

Coutinho, Gonçalo F.; Cereijo, J.M. Martínez; Correia, Pedro Miguel Alves Ribeiro; Lopes, Catarina S.; López, Luciano Espino; Muñoz, Delicias; Antunes, Manuel J.

doi:10.1093/ejcts/ezy205

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…1,25 Previous studies report operative mortality of 0.0%–9.8% and 30-day mortality from 1.1% up to 15.5%. 8,12,26,27 In our study, the operative mortality was 2.0%, varying from 0.0% to 8.3% in the different groups; the 30-day mortality was 6.8% (varying from 2.7% to 25.0%). The highest 30-day mortality was encountered in the MS and AS/AR group, which probably reflects both the extreme rarity of these patients in our unit and their advanced heart disease.…”

Section: Discussionmentioning

confidence: 45%

“…Multivalvular surgery has been associated with both increased morbidity and mortality (1,25). Previous studies report operative mortality of 0.0%-9.8% and 30-day mortality from 1.1% up to 15.5% (8,12,26,27). In our study, the operative mortality was 2.0%, varying from 0.0% to 8.3% in the different groups; the 30-day mortality was 6.8% (varying from 2.7% to 25.0%).…”

Section: Survival and Outcomesmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 45%

Section: Survival and Outcomesmentioning

confidence: 99%

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

et al. 2021

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“…In this limited series, a survival benefit was observed only in the subgroup that had undergone mitral valve repair (17 patients). Similar benefits of mitral valve repair have been observed in retrospective series that included patients who had surgery for both AR and MR [31,32], but studies have also been published in which no benefit of mitral repair over replacement was shown [33,34]. Prospective data addressing this issue are currently lacking.…”

Section: Surgery and Prognosismentioning

confidence: 76%

Pathophysiology and management of combined aortic and mitral regurgitation

Unger

Lancellotti

Amzulescu

et al. 2019

Archives of Cardiovascular Diseases

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The combination of aortic and mitral regurgitation is a typical example of a frequent yet understudied multiple valve disease scenario. The aetiology is often rheumatic or degenerative; less frequently it can be induced by drugs or radiation, or caused by infective endocarditis or congenital valvular lesions. Aortic regurgitation resulting in secondary mitral regurgitation is also not uncommon. There are limited data to guide the management of combined aortic and mitral regurgitation. Left ventricular dysfunction is frequent at initial presentation, and even more so postoperatively, suggesting that surgical management should not be delayed, particularly when symptoms occur or when there is evidence of even subtle left ventricular dysfunction. The decision to operate on one or both valves not only depends on the severity of each lesion, but also on several other factors, including age, co-morbidities and frailty, the increased operative risk of double valve surgery, the increased risk of long-term Abbreviations: AHA/ACC, American Heart Association/American College of Cardiology; AR, aortic regurgitation; LV, left ventricle/ventricular; MR, mitral regurgitation.

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“…When both valves require intervention, mitral valve repair should be performed, even if the aortic valve requires replacement. 6 When the aortic valve disease is less severe, two attitudes may be taken, to attempt some form of repair to decrease the degree of regurgitation, e.g., commissural plication and cusp resuspension. Alternatively, the valve may be left untouched, especially in the presence of less than moderate regurgitation.…”

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confidence: 99%