Predictors of the long-term outcome after combined aortic and mitral valvesurgery

Background-The influence of preoperative clinical, hemodynamic, and surgica l procedures on long-term prognosis after combined aortic and mitral valve surgery is not well known. Methods and Results-One hundred seventy patients (mean age, 50.5 years; 101 men and 68 women) who underwent surgery for chronic combined aortic and mi tral valvular disease between 1975 and 1989 were followed up for an average of 10.6 years. Additional repair of tricuspid valve was performed in 29 pa tients (17%), and aortocoronary bypass raft surgery was performed in 7 pati ents (4.1%). The perioperative mortality rate was 4%, and 10- and 20-year s urvival rates were 61% and 33%. Only 12 of 94 deaths (11%) were non-cardiac related. At 10 and 20 years, 57% and 21% of patients were free of reoperat ion, respectively. The main predictors of late survival in univariate analy sis wore age at surgery (P=0.0002). preoperative left ventricular ejection fraction (P=0.002), cardiac index (P=0.007), tricuspid surgery (P=0.03), pu lmonary vascular resistance (P=0.03), NYHA class (P=0.04), and additional a ortocoronary bypass graft surgery (P=0.04). Duration of symptoms, gender, c ause of valvular disease, and type of prosthesis were not predictive of pos toperative outcome. In multivariate stepwise Cox analysis, ejection fractio n (P=0.0008), age at surgery (P=0.0011), and tricuspid surgery (P=0.007) we re independent predictors of late survival. Conclusions-In combined aortic and mitral valve disease, preoperative myoca rdial function is the main predictor of long-term survival. Low operative m ortality rates and good late outcome make valve replacement mandatory befor e deterioration of myocardial function occurs. Additional tricuspid valve d isease requiring surgery significantly decreases the late survival rate.