title: Primary triple valve surgery for advanced rheumatic heart disease in Mainland China: a single-center experience with 871 clinical cases.
abstract: BACKGROUND
  Triple valve surgery (TVS) is still of choice for advanced rheumatic heart disease (RHD), which has been associated with reported poor early and late outcomes. We describe the short- and long-term results after TVS in last two decades in Mainland China.
  
  
  METHODS
  From January 1985 to January 2005, a total of 871 patients (217 men, 654 women), with mean age of 42+/-11 years, underwent primary TVS for isolated advanced RHD. All patients received replacement procedures in mitral and aortic position (845 mechanical, 26 bioprosthetic), and 840 patients received repair procedures and the other 31 received replacement procedures in tricuspid position (9 mechanical, 22 bioprosthetic). Preoperative, perioperative, and postoperative data were retrospectively analyzed and risk factors affecting early and late survival were evaluated.
  
  
  RESULTS
  The 30-day hospital mortality was 8% (n=71). Presence of ascites, New York Heart Association (NYHA) class IV and lower left ventricular ejection fraction (LVEF) were identified as independent risk factors for hospital mortality. Overall long-term survival rate was 71%+/-3% at 5 years, and 59%+/-5% at 10 years. The cardiac survival rate was 75%+/-3% at 5 years and 63%+/-4% at 10 years. The event-free survival rate at 5 years and 10 years was 61%+/-6% and 41%+/-13%, respectively. Multivariate analysis revealed advanced age, NYHA class IV and lower LVEF were associated with increased late mortality. The freedom from thromboembolism and anticoagulation-related hemorrhage at 10 years was 90%+/-4% and 81%+/-5%, respectively. Of the 508 patients still alive, 376 (74%) were in NYHA class I and II.
  
  
  CONCLUSIONS
  Primary TVS for advanced RHD appears to offer satisfactory short- and long-term results with excellent symptomatic improvement. Cardiac-related late mortality following TVS may be improved by early surgical treatment before NYHA class IV or deterioration of LVEF occurs.
authors.affiliation: Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Qing-Qi
authors.initials: QQ
authors.lastname: Han
authors.forename: Zhi-Yun
authors.initials: ZY
authors.lastname: Xu
authors.forename: Bao-Ren
authors.initials: BR
authors.lastname: Zhang
authors.forename: Liang-Jian
authors.initials: LJ
authors.lastname: Zou
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Hao
authors.forename: Sheng-Dong
authors.initials: SD
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000401:mortality