Related Experiment Videos
Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients
A C Galloway1, E A Grossi, F G Baumann
1Department of Surgery, New York University Medical Center, New York 10016.
Insights
Multiple valve operations in cardiac surgery significantly improved patient outcomes, with 80% achieving better functional class. Key risk factors for decreased survival included high pulmonary artery pressure and triple valve procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
Background:
- Multiple-valve operations were performed during the early blood cardioplegia era.
- Patients often presented with advanced New York Heart Association (NYHA) functional class III (41%) and IV (54%).
Purpose of the Study:
- To assess outcomes and identify incremental risk factors for multiple-valve operations.
- To evaluate the effectiveness of aggressive surgical therapy in patients with advanced valvular heart disease.
Main Methods:
- Follow-up data collected on 97% of 513 patients who underwent multiple-valve procedures between 1976 and 1985.
- Hazard function analysis used to identify significant risk factors for mortality.
Main Results:
- Overall hospital mortality was 12.5%, with a 5-year survival rate of 67.1%.
- Significant risk factors for decreased survival included elevated systolic pulmonary artery pressure, older age, triple valve procedures, concomitant coronary bypass, and prior cardiac surgery.
- Postoperative improvement to NYHA functional class I or II was observed in 80% of patients.
- Five-year freedom from valve-related morbidity and mortality was 71.7%.
Conclusions:
- Multiple valve operations demonstrate excellent clinical improvement and late survival in patients with advanced valvular heart disease.
- Aggressive surgical intervention is justified for these high-risk patients.
Abstract:
To assess the results and incremental risk factors affecting outcome after multiple-valve operation in the early blood cardioplegia era of cardiac surgery, follow-up data (mean +/- SD 3.1 +/- 2 years) were obtained on 97% of 513 patients (mean age +/- SD 58.8 +/- 10.5 years) who underwent a multiple-valve procedure between June 1976 and August 1985. Preoperatively 41% of patients were in New York Heart Association functional class III and 54% in class IV. Three groups accounted for 98.6% of the patients: 57.7% had an aortic and mitral valve procedure, 29% had a mitral and tricuspid valve procedure and 11.9% had a triple-valve procedure. The overall hospital mortality rate was 12.5% and overall 5-year survival rate was 67.1%. Hazard function analysis for all deaths revealed systolic pulmonary artery pressure (p less than 0.0001), age (p = 0.005), triple valve procedure (p less than 0.005), concomitant coronary bypass operation (p less than 0.005) and prior cardiac surgery (p less than 0.002) as the significant incremental risk factors predicting decreased survival in the early hazard phase; diabetes (p less than 0.005) predicted decreased survival in the late hazard phase. Postoperatively the condition of 80% of the patients improved to functional class I or II; only 0.6% remained in functional class IV. The 5-year rate of freedom from late combined valve-related morbidity was 81.7% and that of freedom from late combined valve-related morbidity and mortality was 71.7%. These results demonstrate excellent clinical improvement and late survival after multiple valve operation in patients with advanced valvular heart disease, justifying aggressive surgical therapy in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)