Concomitant aortic and mitral surgery: To replace or repair the mitral valve?

Objectives: The study objectives were to evaluate the perioperative outcomes of concomitant mitral and aortic valve surgery and to determine the influence of mitral valve repair versus replacement on survival and adverse events. Methods: The study population comprised 261 patients with a mean age of 61.3 +/- 11.2 (19-82) years; 57.5% were male, and 73% were in New York Heart Association class III or IV. Mitral valve repair was performed in 209 patients (80%), and mitral valve replacement was performed in 52 patients (20%). Follow-up was complete for 95% of the patients (1395 patient-years). We specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. Results: Degenerative and functional mitral regurgitation, and left ventricular dilation and dysfunction were associated with mitral valve repair (P <. 05). Rheumatic disease, chronic obstructive pulmonary disease, redo surgery, mitral calcification, and atrial fibrillation were more frequently related to mitral valve replacement (P <. 05). Overall 30-day mortality was 1.1% (3 patients). Overall 1-, 5-, and 8-year survival were 98.0% +/- 2.0%, 85.9% +/- 6.1%, and 79.8% +/- 8.2%, respectively, for the mitral valve replacement group and 95.3% +/- 1.5%, 87.4% +/- 2.6%, and 75.2% +/- 4.0%, respectively, for the mitral valve repair group (P = .906). This was confirmed by comparable survival in propensity-matched analyses. Mitral valve repair showed a survival advantage in older patients (aged >= 65 years) and patients with nonrheumatic mitral valves (P = .017 and P = .034, respectively). Bleeding events (83% vs 60%), endocarditis (97.6% vs 84.6%), and reoperation (97.6% vs 86.9%) were higher in those undergoing mitral valve replacement. Freedom from major adverse valve-related events was higher for the mitral valve repair group (P = .002). Mitral valve replacement was identified as an independent risk factor for major adverse valve-related events (hazard ratio, 1.99; P = .018). Conclusions: Concomitant mitral and aortic valve surgery carries a low surgical risk. The choice of the mitral procedure did not significantly affect survival. However, mitral valve replacement was associated with an increased incidence of adverse events. Thus, valve repair, whenever feasible, is a better option.