title: Mitral valve repair versus replacement in simultaneous aortic and mitral valve surgery.
abstract: BACKGROUND
  Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated.
  
  
  METHODS
  A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival.
  
  
  RESULTS
  The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age >70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival.
  
  
  CONCLUSIONS
  In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation.
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Urban
authors.forename: Jan
authors.initials: J
authors.lastname: Pirk
authors.forename: Ondrej
authors.initials: O
authors.lastname: Szarszoi
authors.forename: Ivo
authors.initials: I
authors.lastname: Skalsky
authors.forename: Jiri
authors.initials: J
authors.lastname: Maly
authors.forename: Ivan
authors.initials: I
authors.lastname: Netuka
keywords: Aortic valve replacement; Double valve surgery; Mitral valve repair; Mitral valve replacement