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  • Title: Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement.
    Author: Talwar S, Mathur A, Choudhary SK, Singh R, Kumar AS.
    Journal: Ann Thorac Surg; 2007 Oct; 84(4):1219-25. PubMed ID: 17888973.
    Abstract:
    BACKGROUND: Double valve replacement is associated with reduced long-term survival. This study investigates aortic valve replacement with mitral valve repair as an alternative to double valve replacement in patients with rheumatic heart disease (RHD). METHODS: Between January 1995 and December 2005, 369 patients with RHD underwent combined aortic and mitral valve procedures. In 76 patients (20.6%), mitral valve repair with aortic valve replacement (group 1) was done. The remaining 293 patients (79.4%) underwent double valve replacement (group 2). A total of 351 patients (95%)--73 (96%) in group 1 and 278 (94.8%) in group 2--were 50 years of age or younger. RESULTS: There was no difference in early mortality in the groups (4 in group 1 versus 25 in group 2, p = 0.35). The median follow-up was 60 months (range, 6 to 132 months) and 96% complete in group 1 and 92% in group 2. Actuarial survival was 90.5% +/- 3.4% in group 1 and 81.60% +/- 2.4% in group 2 at 60 months (p = 0.07). Event-free survival at 60 months was 78.3% +/- 5.1% in group 1 and 48.4 % +/- 3.2% in group 2 (p < 0.001). Reoperation-free survival was 92.5% +/- 0.4% in group 1 and 99.5% +/- 0.05% in group 2 (p = 0.014). CONCLUSIONS: Mitral valve repair with aortic valve replacement provides significantly better event-free survival than double valve replacement without a better actuarial survival. Reoperation rates are higher in the mitral valve repair and aortic valve replacement group, whereas thromboembolic complications were more in the double valve replacement group. Better event-free survival in patients undergoing mitral valve repair and aortic valve replacement still argues in favor of repair of the mitral valve whenever possible.
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