title: Outcomes of patients undergoing concomitant mitral and aortic valve surgery: results from an Italian regional cardiac surgery registry.
abstract: OBJECTIVE
  There are limited reliable data on the long-term survival of patients operated upon with double-valve surgery (DVS) in the literature. In this study, in-hospital mortality and 5-year survival were determined and the potential risk factors for increased mortality were identified and discussed.
  
  
  METHODS
  This is a report of an observational retrospective study of 1167 patients undergoing concomitant aortic and mitral valve surgery from 2002 to 2011. Data were prospectively collected in a regional database from Emilia-Romagna (Italy).
  
  
  RESULTS
  The overall in-hospital mortality rate for DVS was 6.9%. Both in-hospital and 1-year mortality were statistically significant between age groups. In-hospital mortality was significantly higher for patients with a smaller body mass index (BMI), for those who had concomitant coronary artery bypass grafting (CABG) and those who received mitral valve replacement (MVR) instead of plasty (MVP). In-hospital and 1-year mortality were highest in patients ≥70 who had implantation of mitral and aortic mechanical valves. There were significant differences in 5-year follow-up survival according to age, BMI and concomitant CABG. The choice of MVR and MVP did not affect 5-year survival. Multivariable analysis showed that patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation or other intraoperative variables.
  
  
  CONCLUSIONS
  Advanced age, smaller BMI and concomitant CABG are significant risk factors for mortality in DVS. MVP provided comparable 5-year outcomes with MVR. Multivariable analysis demonstrates that preoperative and clinical patient-related factors are the real burden in the successful treatment of patients undergoing double-valve procedures.
authors.affiliation: Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy francesco.nicolini@unipr.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Cardiac Surgery Unit, Department of Cardio-Nephro-Pulmonary, Parma Hospital, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.affiliation: Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fortuna
authors.affiliation: Cardiac Surgery Unit, Department of Cardio-Nephro-Pulmonary, Parma Hospital, Parma, Italy.
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: Contini
authors.affiliation: Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Clinical Surgical Cardiology and Thoraco Vascular, Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Lugo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Zussa
authors.affiliation: Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy.
authors.forename: Florio
authors.initials: F
authors.lastname: Pigini
authors.affiliation: Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic valve; Cardiac surgery; Mitral valve; Valve prostheses