title: Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty.
abstract: BACKGROUND
  We examined predictors of early and very long-term outcome after combined mitral and tricuspid valve repair for rheumatic disease.
  
  
  RESULTS
  Between 1974 and 2002, 153 consecutive patients (mean age, 46.0+/-13.2 years) underwent combined mitral and tricuspid valve repair for rheumatic disease. Mitral disease was predominantly stenosis (82.3%); 100% of patients had organic tricuspid valve disease, predominantly with regurgitation (53.6%) or some degree of tricuspid stenosis (46.4%). Mitral repair included commissurotomy in 132 patients (86.3%) associated with a flexible annuloplasty in 108. Tricuspid valve repair included flexible annuloplasty in 68 patients (44.4%) and suture annuloplasty in 20 patients (13.1%) combined with tricuspid commissurotomy in 62 patients (42.5%). Thirty-day mortality was 5.9%. Late mortality was 60.1%. The median follow-up was 15.8 years (interquartile range, 6 to 19 years). Follow-up was 97.9% complete. Age>65 years was the only predictor of late mortality. Kaplan-Meier survival probability was 74.4% at 10 years and 57.0% at 15 years. Sixty-three patients required valve reoperation (mitral valve, 59; tricuspid valve, 38). Predictors of valve reoperations were either mitral or tricuspid commissurotomy without associated prosthetic ring annuloplasty. At 20 years, Kaplan-Meier freedom from reoperation was 48.5+/-5.1%.
  
  
  CONCLUSIONS
  Combined mitral and tricuspid valve repair in rheumatic disease showed satisfactory early results. Long-term results were poor because of high mortality and a high number of valve-related reoperations. The use of prosthetic ring annuloplasty was significantly associated with a reduced incidence of both mitral and tricuspid valve reoperations.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, and Universidad de Cantabria, E-39008 Santander, Spain. bernal@humv.es
authors.forename: José M
authors.initials: JM
authors.lastname: Bernal
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pontón
authors.forename: Begoña
authors.initials: B
authors.lastname: Diaz
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Iván
authors.initials: I
authors.lastname: García
authors.forename: J Aurelio
authors.initials: JA
authors.lastname: Sarralde
authors.forename: Jesús
authors.initials: J
authors.lastname: Gutiérrez-Morlote
authors.forename: Carolina
authors.initials: C
authors.lastname: Pérez-Negueruela
authors.forename: José M
authors.initials: JM
authors.lastname: Revuelta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000401:mortality* / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult