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Ann Thorac Surg 2003;76:487-492
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Bivalvular mechanical Mitral-Aortic valve replacement in 254 patients: Long-Term results—a 22-year follow-up

^a Cardiovascular Surgery Unit, G and R Laënnec University Hospital, Nantes, France
^b Department of Cardiology, Amiens, France

Accepted for publication February 27, 2003.

^* Address reprint requests to Dr Remadi, Cardiac Surgery Unit, Hôpital Sud, 80054 Amiens, France.
e-mail: remadi.jean-paul{at}chu-amiens.fr

BACKGROUND: We have retrospectively studied 254 patients who underwent a bivalvular mechanical mitral-aortic replacement in the cardiovascular and thoracic surgery unit of Nantes from 1979 to 1989. The follow-up was 22 years (1979 to 2001). The last patient was operated on 12 years before the end of the follow-up.

METHODS: All mitral prostheses were St. Jude Medical (SJM) bileaflet valves, and the aortic prostheses were 124 monodisc Björk-Shiley valves, 3 Sorin prostheses, and 127 St. Jude Medical bileaflet prostheses. The mean age was 56.8 ± 8.5 years with a sex ratio equal to 1. Rheumatism as the etiology predominated with 79.5%. Ninety-seven percent of the patients were followed for a total of 2,779 patient-years and a mean of 11.7 years.

RESULTS: Operative mortality was 7.08%. Freedom from overall mortality and valve-related mortality at 22 years were 45.7% ± 3.6% and 73.1% ± 3%, respectively. The linearized rates of thromboembolic and hemorrhagic events were 1.07% and 0.9% per patient-year, respectively. Multivariate analysis showed age (p < 0.002), sex (p < 0.01), and degenerative etiology (p = 0.04) as independent factors of late mortality, and age, sex, degenerative disease, and tricuspid pathology were related to valve-related mortality.

CONCLUSIONS: This study shows good results after mechanical mitral-aortic replacement in terms of survival rate and quality of life in surviving patients, and outlines the factors influencing long-term results as compared with isolated mitral valve replacement.

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