title: 25-year experience with 456 combined mitral and aortic valve replacement for rheumatic heart disease.
abstract: BACKGROUND
  Valvular heart disease in developing countries resulting from rheumatic fever is disabling and if untreated leads to congestive heart failure and death. Valve replacement has remained the procedure of choice for advanced valve disease.
  
  
  METHODS
  Between 1973 and 1997, 456 patients underwent combined mitral and aortic valve replacement. In light of our favorable earlier experience the Starr-Edwards ball valve prostheses were implanted in 90% and 72.8% of mitral and aortic positions, respectively. Follow-up ranged from 1 to 24 years with a median of 8.5 years.
  
  
  RESULTS
  The 30-day hospital death rate was 9.2% and late death occurred in 10.1%. A low-intensity anticoagulant regimen was followed to maintain the target prothrombin time at 1.5 times the control value. The actuarial survival at 5, 10, 20, and 24 years was 90.4%, 85.6%, 84.4%, and 82.4% per year, respectively.
  
  
  CONCLUSIONS
  In view of the acknowledged advantage of superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered sufficient protection against thromboembolism as well as hemorrhage.
authors.affiliation: Department of Cardiothoracic Surgery, Christian Medical College Hospital, Vellore, India.
authors.forename: S
authors.initials: S
authors.lastname: John
authors.forename: E
authors.initials: E
authors.lastname: Ravikumar
authors.forename: C N
authors.initials: CN
authors.lastname: John
authors.forename: V V
authors.initials: VV
authors.lastname: Bashi
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012214:Rheumatic Heart Disease / Q000601:surgery*; D016019:Survival Analysis