title: Early and late results of combined mitral-aortic valve surgery.
abstract: OBJECTIVE
  This retrospective study was designed to assess the early morbidity and mortality as well as long-term mortality of combined aortic-mitral valve procedures at a single centre.
  
  
  METHODS
  Patients were identified by analysing the intensive care and perfusion databases, from 1989 to 2003, with 113 receiving aortic-mitral valve procedures. Eighty-four percent of patients received a mechanical bileaflet valve. Survival was assessed using a Kaplan-Meier method, and determinants of survival with the Cox proportional hazards model.
  
  
  RESULTS
  There were 57 men and 56 women, median age 59 (18-84) years. The 30-day mortality was 9% (n=10). This cohort contained a number of high risk patients, 38% were classified as New York Heart Association class IV, 33.5% had at least moderate ventricular impairment, 20% were redo procedures and 17% urgent procedures. Survival estimates at 5 and 10 years were 85% (0.76-0.90) and 65% (0.49-0.77), respectively. Multivariate pre-operative predictors of death included renal dysfunction (creatinine >200 micromol/L) and hypertension. Rheumatic aetiology was associated with improved survival.
  
  
  CONCLUSIONS
  This study shows acceptable short and long-term survival in patients undergoing combined aortic-mitral valve surgical procedures at a single centre. Renal impairment and hypertension were associated with a poorer long-term prognosis and rheumatic aetiology was associated with improved survival. Age, LVEF and NYHA class were not associated with a worse outcome. This may affect future decision making in light of an aging population.
authors.affiliation: Department of Cardiology, St Vincent's Hospital Melbourne, Victoria 3065, Australia. connelly@medstv.unimelb.edu.au
authors.forename: K A
authors.initials: KA
authors.lastname: Connelly
authors.forename: L
authors.initials: L
authors.lastname: Creati
authors.forename: W
authors.initials: W
authors.lastname: Lyon
authors.forename: M
authors.initials: M
authors.lastname: Yii
authors.forename: A
authors.initials: A
authors.lastname: Rosalion
authors.forename: A C
authors.initials: AC
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Santamaria
authors.forename: V M
authors.initials: VM
authors.lastname: Jelinek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis