Predictors of operative survival after valve replacement

To identify the independent predictors of operative mortality, we examined 31 preoperative clinical and hemodynamic variables in 2,488 patients undergoing valvular surgery between 1982 and 1986. The operative mortality was 5.3% in 1,098 patients after aortic valve surgery, 6.6% in 1,107 after mitral valve surgery, and 10.1% in 283 after double valve surgery. Multivariate statistical analysis demonstrated that urgent surgery, endocarditis requiring urgent surgery, previous aortic valve surgery, coronary artery disease, and age were independent risk factors for aortic valve surgery. Urgent surgery, endocarditis, age, coronary artery disease, and preoperative ventricular ejection fraction were independent predictors of mortality after mitral valve surgery. The predictors of mortality after double valve surgery were urgent surgery, age, preoperative ventricular ejection fraction, and tricuspid valve disease. Gender and the type of valvular lesion, procedure, and prosthesis did not independently influence operative mortality. Strategies to diminish operative mortality should include careful assessment of the risks and benefits in elderly patients, early operative intervention before deterioration that necessitates urgent surgery, and use of improved techniques of myocardial protection in high-risk subgroups.