MITRAL-VALVE REPAIR COMBINED WITH AORTIC-VALVE REPLACEMENT

Background and aims of the study: Combined aortic and mitral valve rep lacement continues to result in significant morbidity and mortality. A lthough mitral repair has improved the results of mitral valve surgery , its influence on combined aortic valve replacement has not been asse ssed. Methods: We reviewed 38 consecutive patients who underwent aorti c valve replacement (AVR) and mitral repair (MR) between 1985 and 1995 . The average age was 57 years; 20 were men and 18 women. Nineteen pat ients were considered high risk: six had previous cardiac surgery, thr ee were on chronic dialysis, two required emergency surgery for low ou tput syndrome, one had a chronic tracheotomy for chronic lung disease, and seven had left ventricular ejection fraction <30%. MR consisted o f ring application alone in 28 patients, chordal shortening in nine, p osterior leaflet transfer in six and posterior leaflet resection in fo ur. AVR was accomplished with 21 bioprostheses, 14 mechanical and thre e allograft valves. The mean (+/- SD) cross-clamp time was 133 +/- 41 min. Additional procedures included coronary bypass in six patients an d tricuspid procedures in three. Results: There were no operative deat hs. Six patients died between 4 and 73 months postoperatively. Patient survival was 75% five and 67% 10 years after surgery. The causes of d eath were heart failure (two cases), and respiratory failure, drug ove rdose, electrolyte imbalance and unknown (one each). Logistic risk ana lysis was significant for females and rheumatic valve disease, bacteri al endocarditis, and degenerated valve patients. During follow up ther e were no valve failures or endocarditis, but three embolic episodes o ccurred without permanent sequel. Conclusions: With increased surgical expertise, improved myocardial protection of MR combined with AVR off ers excellent short- and long-term results, optimal chordal preservati on, no valve failure and no endocarditis; it is the ideal choice where anticoagulation is contraindicated. The prolonged crossclamp time was well tolerated.