Early and late results with combined mitral and aortic valve replacement

From February 1977 to January 1993, a total of 52 patients have undergone combined mitral and aortic valve replacement (MAVR) at the Fukuoka University Hospital. The ages at operation ranged from 35 to 72 years (mean, 55.3 years) for 16 males and 36 females. Twenty-five patients received two bioprosthetic valves (group BB); 6 received a combination of bioprosthetic valve and mechanical valve (group BM); and 21 received two mechanical valves (group MM). The previous intra-cardiac operations were performed on 24 patients (46.2%). The purpose of this study was to learn about the long-term clinical results of MAVR and to analyze the difference among three groups. Seven patients died within 30 days of operation or during initial hospitalization (early mortality: 13.5%). Two patients died at late period, 5.8 years and 6.9 years after operation, respectively (linearized occurrence rate: 0.9%/pt-yr). Patient survival rate including operative death was 82.9% +/- 5.7% at 5 years and 79.0% +/- 6.7% at 8 years in the total number of patients. Thromboembolism occurred in 2 patients in group MM (0.9%/pt-yr). Anticoagulant-related hemorrhage occurred only in 1 patient (0.4%/pt-yr in overall), in whom two bioprosthetic valves were implanted (group BB), in spite of being in good control with anticoagulants. No infective endocarditis was encountered in any patients during any of the periods. Reoperations were performed in 7 patients (3%/pt-yr in overall), 5 in group BB and 2 in group MM. Percentage freedom from reoperation was 86.4% +/- 5.9% at 5 years and 78.2% +/- 7.7% at 8 years in all. There was no difference among the three groups. Percentage freedom from overall morbidity and mortality was 74.5% +/- 6.9% at 5 years in all. Group MM showed higher morbidity and mortality at 8 years than other groups, but there were no significance (MM: 52.4% +/- 17.6%, BB: 76.5% +/- 9.5%, BM: 83.3% +/- 15.2%). We conclude that there were no significant differences in long-term results of NAVR which consisted of the following combinations of prostheses such as BB, BM, and MM. Redoing MAVR with New York Heart Association functional class IV and emergency cases were considered as in-hospital risk factors.