Original ArticleEarly and Late Results of Combined Mitral-Aortic Valve Surgery
Introduction
Advances in cardiac surgical techniques over the past two decades have seen a wider range of treatment options for valvular heart disease, which include valvular repair, valvuloplasty and/or valve replacement. Whilst double valve replacement (DVR) comprises approximately 2% of open-heart surgery cases, it has been regarded as a higher risk operation than other procedures such as single valve replacement.1 Factors associated with adverse outcome in the past have included older age,2, 3 New York Heart Association (NYHA) class III or IV,2, 3, 4 low left ventricular ejection fraction,5 and concomitant coronary artery bypass surgery (CABG).6 In the past studies, double valve replacement has been associated with peri-operative morbidity and mortality of 3–15%.6, 7, 8, 9 The purpose of this study was to determine the 30-day mortality rates, and all cause mortality during the follow up period (1989 to May 2004) at a medium sized single centre. Furthermore, we analysed the data set in an attempt to determine factors which may be associated with a poor outcome.
Section snippets
Patient Population
Between January 1993 and January 2003, 113 patients, 57 men and 56 women, median age 59 years (range 18–84 years) were identified by the hospital's Intensive Care and Cardiac surgical and perfusion unit databases as undergoing double valve replacement. Patients having concomitant bypass grafting were included. The campus includes both public and private open heart surgical units (OHSU). The same group of eight surgeons, anaesthetists and cardiac perfusionists worked in both public and private
Results
The median ICU stay was two days (range 1–28 days), and median hospital stay was nine days (range 6–85).
Discussion
The 30-day mortality for double valve replacement in this single centre study was 9%. Pump failure/low cardiac output syndrome was the predominant cause in his group. Early morbidity was significant, with around one-third of patients suffering a significant complication.
The cohort studied contained 46 patients, who, based upon prior studies5, 9, 12, 13 were at higher risk of significant morbidity and mortality as evidenced by the LV grade, NYHA class, age, percentage of redo procedures as well
Limitations
This study suffers some limitations. The retrospective nature of the study can introduce selection bias. Furthermore, follow-up was not complete with 94% of patient data available for long-term survival modelling. Finally, the relatively small number of events (26 deaths of 113 patients) results in wide confidence intervals which could reduce the validity of the findings. Despite these caveats, this study's strength is that it represents a medium sized cardiac surgical unit's results which are
Conclusion
Within the limits of a retrospective study, the data presented is a modern day cohort of patients undergoing DVR in a medium sized single centre. The results are in keeping with published literature, and analysis of late mortality demonstrates a high risk group consisting of pre-existing hypertension and renal impairment/failure. Age, NYHA status and LVEF were not predictive of early or long-term mortality, which needs to be factored into the decision to repair/replace valves in an increasing
Acknowledgements
Dr Kim Connelly is supported by a Postgraduate research award from the National Heart Foundation of Australia PC 02M 0875, a Pfizer Cardiovascular Research grant, an NHMRC Neil Hamilton Fairley scholarship (ID 447712) and a TACTICS grant (Canada).
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