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(Circulation. 2009;120:S155-S162.)
© 2009 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Outcomes of Patients Undergoing Concomitant Aortic and Mitral Valve Surgery in Northern New England

Bruce J. Leavitt, MD; Yvon R. Baribeau, MD; Anthony W. DiScipio, MD; Cathy S. Ross, MS; Reed D. Quinn, MD; Elaine M. Olmstead, BA; Donato Sisto, MD; Donald S. Likosky, PhD; Richard P. Cochran, MD; Robert A. Clough, MD; Richard A. Boss, Jr, MD; Robert S. Kramer, MD; Gerald T. O'Connor, PhD, ScD, for the Northern New England Cardiovascular Disease Study Group

From Fletcher Allen Health Care (B.J.L.), Burlington, Vt; Catholic Medical Center (Y.R.B.), Manchester, NH; Dartmouth-Hitchcock Medical Center (A.W.D.), Lebanon, NH; Dartmouth Institute for Health Policy and Clinical Practice (C.S.R., G.T.O.), Dartmouth College, Lebanon, NH; Maine Medical Center (R.D.Q., R.S.K.), Portland, Me; Dartmouth Medical School (E.M.O., D.S.L.), Lebanon, NH; Portsmouth Regional Hospital (D.S.), Portsmouth, NH; Central Maine Medical Center (R.P.C.), Lewiston, Me; Eastern Maine Medical Center (R.A.C.), Bangor, Me; and Concord Hospital (R.A.B. Jr), Concord, NH.

Correspondence to Bruce J. Leavitt, MD, Fletcher Allen Health Care, 111 Colchester Ave, Burlington, VT 05401-1473. E-mail bruce.leavitt{at}vtmednet.org

Background— Concomitant aortic (AV) and mitral (MV) valve surgery accounts for 4% of all valve procedures in northern New England. We examined in-hospital and long-term mortality.

Methods and Results— This is a report of a prospective study of 1057 patients undergoing concomitant AV and MV surgery from 1989 to 2007. The Social Security Administration Death Master File was used to assess long-term survival. Kaplan–Meier and log-rank tests were performed. In-hospital mortality was 15.5% (11.0% for patients <70 years, 18.0% for 70- to 79-year-olds, and 24% for those 80 years). Overall median survival was 7.3 years. Median survival without coronary artery bypass grafting was 9.5 years and with coronary artery bypass grafting was 5.7 years (P<0.001). Survival in women was worse than in men (7.3 versus 9.3, years, P=0.033). Median survival by age was 11.0 years for patients <70 years, 5.4 years for 70- to 79-year-olds, and 4.8 years for those 80 years. Median survival was not significantly different for patients 80 years compared with those who were 70 to 79 years old (P=0.245).

Conclusions— Double-valve surgery has a high in-hospital mortality rate and a median survival of 7.3 years. After patients have survived surgery, long-term survival is similar between men and women, smaller and larger patients, and those receiving MV repair or replacement. Survival continues to decline after surviving surgery for patients 70 years old and those who undergo concomitant coronary artery bypass grafting. In patients <70 years, either mechanical valves in both positions or a tissue AV and mitral repair have the lowest in-hospital mortality and the best long-term survival. In patients 70 years, tissue valves in both positions have the best in-hospital and long-term survival.

Key Words: cardiopulmonary bypass • mortality • revascularization • survival • valves