title: Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes.
abstract: OBJECTIVE
  This study was undertaken to evaluate the late outcomes of reconstruction of the intervalvular fibrous body during aortic and mitral valve replacement.
  
  
  METHODS
  Seventy-six consecutive patients underwent reconstruction of the intervalvular fibrous body with replacement of the mitral and aortic valves. There were 35 men and 41 women whose mean age was 58 +/- 12 years. Additional procedures were circumferential reconstruction of the mitral annulus in 27 patients, tricuspid valve repair in 21, coronary artery bypass in 15, and aortic root replacement in 4. Indications for the operation were active infective endocarditis with abscess in 15 patients, extensive calcification of the mitral annulus and interventricular fibrous body in 24, lack of fibrous tissue to secure a prosthetic valve in 17, and treatment or prevention of patient-prosthesis mismatch in 20. Fifty-five patients had undergone one or more previous valve operations, and 52 (68%) were in functional class IV. The mean follow-up was 47 +/- 47 months, and it was complete.
  
  
  RESULTS
  There were 8 (10%) operative and 18 (24%) late deaths. The 10-year survival was 50% +/- 9%. There were 15 reoperations in 12 patients: 7 for prosthetic valve endocarditis (5 early, 2 late), 7 for patch or valve dehiscence (3 early, 4 late), and 1 for structural valve deterioration. All but 2 reoperations were re-reconstruction of the intervalvular fibrous body and double valve replacement. The 10-year freedom from reoperation was 73% +/- 7%.
  
  
  CONCLUSIONS
  Reconstruction of the intervalvular fibrous body during double valve replacement is a technically challenging operation, but it is useful in patients with complex valve pathology for whom no alternative procedure is available.
authors.affiliation: Division of Cardiovascular Surgery of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nilto C
authors.initials: NC
authors.lastname: De Oliveira
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome