[Have the results of mitral valve replacement improved?]

The operative mortality following valvular surgery remains substantial for specific high risk groups despite recent improvement in surgical techniques, anesthetic managements, and postoperative care. To test the contention that the results of valvular surgery are better in recent years, we examined patients undergoing isolated or combined mitral valve replacement in an earlier era (1980-1984; n = 68) and a later era (1985-1989; n = 106). There were no significant differences concerning the clinical characteristics between an earlier era and a later era, although patients in an earlier era were more seriously in hemodynamics, and in a later era were older, a higher prevalence of reoperations and a combined tricuspid valve surgery. The operative mortality was 10.3% in an earlier era, 6.6% in a later era, and so it is not significantly improved in a recent 5 years, however the incidence of premature death (death within 30 days) except valve re-replacement was significantly improved. Using univariate multiple logistic model, the predictors for operative death after mitral valve replacement in an earlier era were advanced NYHA functional class, larger CTR, higher systolic pulmonary pressure and pulmonary capillary wedge pressure, associated preoperative organ dysfunction and heart lung machine time. In a later era, these were advanced NYHA functional class, higher right atrial mean pressure, associated preoperative organ dysfunction, valve re-replacement, heart lung machine time and aortic cross clamp time. Multivariate analysis including these significant factors could not demonstrated the most independent predictors of operative mortality after mitral valve replacement in both an earlier era and a later era.(ABSTRACT TRUNCATED AT 250 WORDS)