title: Outcome of double vs. single valve replacement for rheumatic heart disease.
abstract: OBJECTIVE
  To compare the follow-up results of double valve replacement (DVR) i.e. mitral valve replacement (MVR) and aortic valve replacement (AVR) vs. isolated MVR or AVR for rheumatic heart disease.
  
  
  METHODS
  An interventional qausi-experimental study.
  
  
  METHODS
  Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, from September 1994 till December 2007.
  
  
  METHODS
  Prospective follow-up of 493 patients with mechanical heart valves was carried out using clinical assessment, international normalized ratio and echocardiography. Patients were divided into three groups: group I having MVR, group II having AVR and group III having DVR. Survival, time and causes of mortality, and frequency of valve thrombosis, haemorrhage and cerebrovascular haemorrhage was noted in the three groups and described as proportions. Actuarial survival was analyzed by Kaplan-Meier method.
  
  
  RESULTS
  There were 493 with 287 (58.3%) in group I, 87 (17.6%) in group II and 119 (24.1%) in group III. Total follow-up was 2429.2 patient (pt)-years. Of 77 (15.6%) deaths, 19 (3.8%) were in-hospital and 58 (11.8%) were late. In-hospital mortality was highest 4 (4.6%) in group II followed by 5 (4.2%) group III and 10 (3.5%) group I. Late deaths were 39 (13.4%) in group I, 9 (10.2%) in group II and 10 (8.3%) in group III. The total actuarial survival was 84.4% with survival of 83%, 85.1%, 87.4% in groups I, II and III respectively. On follow-up valve thrombosis occurred in 12 (0.49%/pt-years) patients; 9 (0.67%/pt-years) group I, 1 (0.22%/pt-years) in group II and 2 (0.31%/pt-years) in group III. Severe haemorrhage occurred in 19 (0.78%/pt-years); 14 in (1.04%/pt-years) in group I, 3 (0.66%/pt-years) group II and 2 (0.31%/pt-years) in group III. Cerebrovascular accidents occurred in 34 (1.3%/pt-years); 26 (1.95%/pt-years) in group I and 4 in groups II (0.89%/pt-years) and III (0.62%/pt-years) each.
  
  
  CONCLUSIONS
  In patients with rheumatic heart disease having combined mitral and aortic valve disease DVR should be performed whenever indicated as it has similar in-hospital mortality and better late survival as compared to isolated aortic or mitral valve replacement.
authors.affiliation: Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore. rajapakhtar@gmail.com
authors.forename: Raja Parvez
authors.initials: RP
authors.lastname: Akhtar
authors.forename: Abdul Rehman
authors.initials: AR
authors.lastname: Abid
authors.forename: Mumraiz Salik
authors.initials: MS
authors.lastname: Naqshband
authors.forename: Bilal S
authors.initials: BS
authors.lastname: Mohydin
authors.forename: Jawad Sajid
authors.initials: JS
authors.lastname: Khan
mesh_terms: D000328:Adult; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010154:Pakistan; D012214:Rheumatic Heart Disease / Q000601:surgery*; D055815:Young Adult