title: Outcomes of patients undergoing concomitant aortic and mitral valve surgery in northern new England.
abstract: BACKGROUND
  Concomitant aortic (AV) and mitral (MV) valve surgery accounts for 4% of all valve procedures in northern New England. We examined in-hospital and long-term mortality.
  
  
  RESULTS
  This is a report of a prospective study of 1057 patients undergoing concomitant AV and MV surgery from 1989 to 2007. The Social Security Administration Death Master File was used to assess long-term survival. Kaplan-Meier and log-rank tests were performed. In-hospital mortality was 15.5% (11.0% for patients <70 years, 18.0% for 70- to 79-year-olds, and 24% for those > or =80 years). Overall median survival was 7.3 years. Median survival without coronary artery bypass grafting was 9.5 years and with coronary artery bypass grafting was 5.7 years (P<0.001). Survival in women was worse than in men (7.3 versus 9.3, years, P=0.033). Median survival by age was 11.0 years for patients <70 years, 5.4 years for 70- to 79-year-olds, and 4.8 years for those > or =80 years. Median survival was not significantly different for patients > or =80 years compared with those who were 70 to 79 years old (P=0.245).
  
  
  CONCLUSIONS
  Double-valve surgery has a high in-hospital mortality rate and a median survival of 7.3 years. After patients have survived surgery, long-term survival is similar between men and women, smaller and larger patients, and those receiving MV repair or replacement. Survival continues to decline after surviving surgery for patients > or =70 years old and those who undergo concomitant coronary artery bypass grafting. In patients <70 years, either mechanical valves in both positions or a tissue AV and mitral repair have the lowest in-hospital mortality and the best long-term survival. In patients > or =70 years, tissue valves in both positions have the best in-hospital and long-term survival.
authors.affiliation: Fletcher Allen Health Care, Burlington, VT 05401-1473, USA. bruce.leavitt@vtmednet.org
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Leavitt
authors.forename: Yvon R
authors.initials: YR
authors.lastname: Baribeau
authors.forename: Anthony W
authors.initials: AW
authors.lastname: DiScipio
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Ross
authors.forename: Reed D
authors.initials: RD
authors.lastname: Quinn
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Olmstead
authors.forename: Donato
authors.initials: D
authors.lastname: Sisto
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: Richard P
authors.initials: RP
authors.lastname: Cochran
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clough
authors.forename: Richard A
authors.initials: RA
authors.lastname: Boss
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kramer
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome