Double cardiac valve replacement: a community hospital experience

The morbidity and mortality of double cardiac valve replacement were assessed in a community hospital setting. Four hundred twenty-two cardiac patients undergoing valve replacement from 1977 to 1991 were analyzed. Forty-two patients underwent double valve replacement. The clinical variables associated with increased operative mortality (early and late) were determined. The overall operative mortality rate for valve replacement was 7.87% (29 of 422 patients). The mortality rate was 9.09% (3/33 patients) for double valve replacement and 11.11% (1/9 patients) for double valve replacement in conjunction with coronary bypass. The clinical variables associated with increased mortality were: significant reduction in preoperative left ventricular ejection fraction (< 35%); advanced age (> 60); presence of ischemic mitral valve disease; and preoperative functional class (New York Heart Association Functional Class IV). The results of this study suggest that strategies to diminish operative mortality should include assessment of risk preoperatively as well as anticipation of high mortality in selected subgroups.