LONG-TERM RESULTS OF MITRAL-AORTIC VALVE OPERATIONS

Objective: We analyzed the long-term morbidity and mortality of our ex perience,vith combined mitral-aortic surgery, as well as their determi nants. Methods: Among 2109 consecutive patients undergoing valve opera tions, 200 had mitral-aortic valve procedures with at least implantati on of a mechanical prosthesis: 163 of 200 (81.5%) patients had double valve replacement and 37 of 200 (18.5%) had mitral valve repair and ao rtic valve replacement. All mechanical valves,were bileaflet prosthese s. Preoperatively, 171 of 200 (85.5%) patients were in New York Heart Association class III-IV. Event-free survivals were determined by mean s of the Kaplan-Meier method and determinants of survivals with the Co x proportional hazards model (p < 0.05) entering 39 preoperative and p erioperative factors. Follow-up was complete for 96% of the patients ( 192/200), Results: Overall survivals at 5, 10, and 15 gears were 88.5% +/- 0.55%, 73.5% +/- 4%, and 53.3% +/- 8.9%, and rates of freedom fro m valve-related mortality were 92.9% +/- 1.5%, 85.8% +/- 3.5%, and 85. 8% +/- 3.5%, The rates of freedom from permanent valve-related impairm ent were 91.5% +/- 1.7%, 85.4% +/- 3.5%, and 79.3% +/- 6.7%, and those from all valve-related mortality and morbidity were 74.1% +/- 2.3%, 5 3.8% +/- 5%, and 49% +/- 5.6%, At last follow-up, 90% (139/154) of the survivors were in New York Heart Association class I-II. Left ventric ular ejection fraction less than 50%, age older than 70 years, and pre operative ventricular arrhythmias were independent risk factors for va lve-related late deaths, Diabetes, ejection fraction less than 50%, an d coronary artery disease were independent determinants of all valve-r elated events. Conclusions: Functional results of survivors of combine d mitral-aortic surgery are excellent. However long-term valve-related morbidity and mortality are substantial. In the patient population st udied, the predictors are determined by patient-related factors, mainl y myocardial factors, but not by valve-related factors.