Outcomes of mitral valve surgery during concomitant aortic valve replacement

J Card Surg. 2018 Nov;33(11):706-715. doi: 10.1111/jocs.13824. Epub 2018 Oct 2.

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.

Keywords: cardiovascular research; concomitant mitral and aortic surgery; valve repair/replacement.

MeSH terms

  • Aged
  • Aortic Valve / surgery*
  • Female
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / surgery*
  • Mitral Valve Annuloplasty / methods*
  • Mitral Valve Annuloplasty / mortality
  • Patient Readmission / statistics & numerical data
  • Proportional Hazards Models
  • Reoperation / statistics & numerical data
  • Risk
  • Survival Rate
  • Time Factors
  • Treatment Outcome