Efficacy of Double Valve Replacement/Repair in Patients with Reduced Left Ventricular Ejection Fractions

Introduction: A reduced left ventricular ejection fraction (LVEF) is a known risk factor for double valve replacement or aortic valve replacement in combination with concomitant mitral valve repair (DVR) and is associated with high morbidity and mortality rates. In this study, we sought to analyze the 30-day mortality and long-term survival rates of patients with reduced LVEFs. Methods: A multicenter, retrospective, observational cohort study of patients who underwent DVR was performed at four centers from January 2016 to December 2021. LVEFs were categorized as 41%-50% (n = 120) or <= 40% (n = 58). For the effects of risk factors on 30-day mortality, binary logistic regression was performed. Survival rates were assessed with the Kaplan-Meier method. Results: A total of 178 patients who underwent DVR were included in this study, of whom 67.42% (n = 120) had LVEFs ranging from 41-50% and 32.58% (n = 58) had LVEFs <= 40%. More mechanical valves and tricuspid valve-forming rings were applied in the LVEF <= 40% group (68.97% versus 53.33%, p = 0.047; 31.03% versus 10.83%, p = 0.001). The 30-day mortality rates of DVR patients with LVEFs ranging from 41-50% and <= 40% were 8.33% and 17.24%, respectively (p = 0.078). During the follow-up period, there were no significant differences in long-term survival (log rank p = 0.75). On multivariable logistic regression analysis, age >65 years [odds ratio (OR): 5.559, 95% confidence interval (CI): 1.668-18.524, p = 0.005] and cardiopulmonary bypass (CPB) duration >200 min (OR: 5.031, 95% CI: 1.773-14.277, p = 0.002) were significantly associated with the likelihood of 30-day mortality. Conclusions: Although the differences in 30-day mortality and long-term survival rates between DVR patients with LVEFs ranging from 41-50% and <= 40% were not statistically significant in our cohort, an age >65 years and a CPB duration >200 min were predictors of 30-day mortality.