title: Associations between valve repair and reduced operative mortality in 21,056 mitral/tricuspid double valve procedures.
abstract: OBJECTIVE
  Repair of either the mitral (M) or tricuspid (T) valve in single valve surgery is associated with reduced operative mortality. It is unclear, however, how valve repair influences mortality in combined MT procedures. This topic was evaluated in the Society of Thoracic Surgeons database.
  
  
  METHODS
  From 1993 through 2007, 21 056 patients underwent concomitant MT valve surgery. Group I had M&T replacement (n = 1130), Group II had M repair and T replacement (n = 216), Group III had M replacement and T repair (n = 11 448) and Group IV had both M&T repair (n = 8262). Unadjusted operative mortalities (UOMs) and morbidities of Groups I-IV were assessed, and logistic regression analysis adjusted for differences in baseline patient profiles. Surgical outcomes were expressed as UOMs, and also adjusted odds ratios (ORs) for mortality.
  
  
  RESULTS
  Group IV was older with more coronary artery bypass grafting and generally less comorbidity, and Group I had more endocarditis, mitral stenosis and reoperation. UOM values were: Group I = 16.8, Group II = 10.2, Group III = 10.3 and Group IV = 8.0%. In the multivariable model, factors influencing mortality included: age (per 5-year increase, OR = 1.15), renal failure with dialysis (OR = 3.22), emergency status (OR = 3.14), second or more reoperations (OR = 1.92) and later surgical date (OR = 0.63). Both M and T repair were independently associated with lower operative mortalities vs prosthetic valve replacement (OR = 0.83 and 0.60, respectively, P < 0.003).
  
  
  CONCLUSIONS
  In MT double valve surgery, repair of either valve is associated with lower risk-adjusted mortality when compared with replacement and, when feasible, multiple valve repair should be considered the optimal treatment. Within the limitations of observational analysis, these data support continued efforts to increase M&T repair rates.
authors.affiliation: Department of Cardiac Surgery, Vanderbilt University, Nashville, TN 37205, USA. jsrankinmd@cs.com
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: Matthew
authors.initials: M
authors.lastname: Williams
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008943:Mitral Valve / Q000601:surgery*; D016017:Odds Ratio; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000601:surgery*
keywords: Mitral valve repair; Multiple valve surgery; Tricuspid valve repair