Long-term outcomes of concomitant aortic and mitral valve repair

Objective: To evaluate the short- and long-term outcomes of concomitant aortic (AVr) and mitral (MVr) valve repair. Methods: This retrospective analysis of prospectively collected data identified patients who had undergone AVr and MVr surgery from March 1996 to October 2009. Patients were included if they had undergone combined repair on the aortic and mitral valves. Excluded were those <18 years in whom valve replacement was performed. Data were collected on the short-term morbidity and mortality (<30 postoperative days), long-term survival, and freedom from valve-related events and echocardiographic outcomes. Results: A total of 65 patients underwent AVr and MVr (mean age, 56.4 +/- 15.8 years, 46 men). Preoperatively, 30 patients (46.1 %) had aortic insufficiency (Al) >2+, 20 patients had Al >= 2+ with aortic dilatation (30.7%), and 4 patients (6.1 %) had aortic dilatation only. Of the 65 patients, 57 had tricuspid (87.6%) and 8 had bicuspid aortic valves (12.3%). All patients had mitral insufficiency preoperatively. One in-hospital death occurred (1.5%). At discharge, no patient had Al >= 2+ versus 30 patients preoperatively (P <.001), and 7 patients had Al >1+ versus 61 patients preoperatively (P <.001). At discharge, the mean left ventricular end-diastolic diameter was 48 7 mm versus 59 +/- 9 mm preoperatively (P <.007), and the mean left ventricular end-systolic diameter was 33 +/- 5 mm versus 38 +/- 14 mm preoperatively (P =.36). The mean clinical follow-up duration was 62 45 months (median, 50; range, 1-177). At the latest follow-up visit, 17 patients were New York Heart Association class >= 2 versus 52 patents preoperatively (P <.001). Four cardiac deaths occurred, and at 1, 5, and 10 years, the freedom from cardiac death was 100%, 93.4% +/- 3.7%, and 88.5% 5.9%, respectively. Eight valve reinterventions were required, and the freedom from valve reintervention at 1, 5, and 10 years was 95.3% +/- 2.6%, 91.6% +/- 3.6%, and 78.4% +/- 8.0%, respectively. At 1, 5, and 10 years, the freedom from Al 2+ was 98.2% +/- 1.7%, 93.4% +/- 3.7%, and 88.3% +/- 5.8% and the freedom from mitral insufficiency 2+ was 96.4% +/- 2.4%, 93.3% +/- 3.8%, and 93.3% +/- 3.8%, respectively. Conclusions: Concomitant AVr/MVr is associated with acceptable survival and freedom from valve reintervention.