title: Durability of combined aortic and mitral valve repair.
abstract: BACKGROUND
  This study was undertaken to determine the durability of combined aortic and mitral valve repair.
  
  
  METHODS
  From 1979 through 1999, 158 patients underwent simultaneous aortic and mitral valve repair. Multivariable, multi-phase hazard function analysis was used to determine risk factors for the outcomes of death and reoperation.
  
  
  RESULTS
  Hospital mortality was 3%. Survival after operation was 97%, 93%, 82%, and 62% after 30 days and 1, 5, and 10 years, respectively. Risk factors for late death included aortic stenosis (p = 0.0001), older age (p = 0.002), and abnormal left ventricular function (p = 0.007). Thirty-six patients required reoperation for valvular dysfunction, and freedom from reoperation was 94%, 82%, and 65% after 1, 5, and 10 years, respectively. Risk factors for reoperation included severe aortic regurgitation (p = 0.004), aortic cusp shaving (p = 0.05), mitral valve chordal transfer (p = 0.004), and bovine pericardial annuloplasty (p = 0.002). Five-year freedoms from endocarditis, thromboembolism, and hemorrhage were 97%, 98%, and 99%, respectively, with freedom from any of these valve-related morbidities of 99%, 95%, and 94% after 1, 5, and 10 years, respectively.
  
  
  CONCLUSIONS
  Double valve repair is associated with acceptable late survival and excellent freedom from valve-related morbidity, but limited durability. Therefore, double valve repair should be reserved for patients who cannot be anticoagulated, and should be used with caution in patients with aortic stenosis, rheumatic valve disease, or anterior mitral leaflet pathology.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. gillinom@ccf.org
authors.forename: A M
authors.initials: AM
authors.lastname: Gillinov
authors.forename: E H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: J
authors.initials: J
authors.lastname: White
authors.forename: M
authors.initials: M
authors.lastname: Howard
authors.forename: R
authors.initials: R
authors.lastname: Ahkrass
authors.forename: A
authors.initials: A
authors.lastname: Marullo
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D009820:Ohio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate