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Ann Thorac Surg 1993;55:631-640
© 1993 The Society of Thoracic Surgeons

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Articles

Relation between choice of prostheses and late outcome in double-valve replacement

Surgery Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA

Accepted for publication June 15, 1992.

^_* Address reprints requests to Dr Clark, Cardiovascular and Pulmonary Research Center, Allegheny-Singer Research Institute, 320 E North Ave, Pittsburgh, PA 15212.

The purpose of this study was to determine if the combination of a mechanical and bioprosthetic valve in the aortic and mitral positions influences late morbidity and mortality when compared with patients who had dual mechanical or dual bioprosthetic valves inserted. We reviewed the course of 89 hospital survivors of combined aortic and mitral valve replacement. The mean postoperative follow-up interval was 6.6 years, with a total follow-up of 583 years (98% complete). At 12 months after operation, mean functional class decreased from 3.1 to 1.7 (p < 0.05) and mean cardiac index increased from 2.1 to 2.5 L · min^–1 · m^–2 (p < 0.05), Actuarial survival for the 89 patients (exclusive of < 30-day or in-hospital mortality, 14%) was 70%, 51%, and 33% at 5, 10, and 15 years. Freedom from reoperation was 93%, 78%, and 68%, and freedom from combined thromboembolism and anticoagulant-related hemorrhage was 82%, 60%, and 50%. These results show that there was no difference in overall survival in patients with dual mechanical valves, dual bioprosthetic valves, or a combination of both types at 15 years. There was, however, a lower reoperation rate in the group with dual mechanical valves as compared with the group with dual bioprosthetic valves (p < 0.05 at 10 years) or with a combination of valves (p < 0.05 at 15 years). The higher the number of mechanical valves the higher the combined risk of thromboembolism and anticoagulant-related hemorrhage. Patients who received one or two Starr-Edwards prostheses had significantly higher rates of thromboembolism and anticoagulant-related hemorrhage and a lower survival than those who received other valve combinations. Patients who received two Hancock bioprostheses had significantly higher rates of reoperation and a decreased incidence of combined thromboembolic and anticoagulant-related hemorrhagic events (p < 0.05 at 10 years). We conclude that combining a mechanical prosthesis and a bioprosthesis in the same patient is disadvantageous.

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