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Ann Thorac Surg 2007;84:1219-1225
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Aortic Valve Replacement With Mitral Valve Repair Compared With Combined Aortic and Mitral Valve Replacement

^a Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
^b Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Accepted for publication April 27, 2007.

^_* Address correspondence to Dr Kumar, Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India (Email: asampath_kumar{at}hotmail.com).

Background: Double valve replacement is associated with reduced long-term survival. This study investigates aortic valve replacement with mitral valve repair as an alternative to double valve replacement in patients with rheumatic heart disease (RHD).

Methods: Between January 1995 and December 2005, 369 patients with RHD underwent combined aortic and mitral valve procedures. In 76 patients (20.6%), mitral valve repair with aortic valve replacement (group 1) was done. The remaining 293 patients (79.4%) underwent double valve replacement (group 2). A total of 351 patients (95%)—73 (96%) in group 1 and 278 (94.8%) in group 2—were 50 years of age or younger.

Results: There was no difference in early mortality in the groups (4 in group 1 versus 25 in group 2, p = 0.35). The median follow-up was 60 months (range, 6 to 132 months) and 96% complete in group 1 and 92% in group 2. Actuarial survival was 90.5% ± 3.4% in group 1 and 81.60% ± 2.4% in group 2 at 60 months (p = 0.07). Event-free survival at 60 months was 78.3% ± 5.1% in group 1 and 48.4 % ± 3.2% in group 2 (p < 0.001). Reoperation-free survival was 92.5% ± 0.4% in group 1 and 99.5% ± 0.05% in group 2 (p = 0.014).

Conclusions: Mitral valve repair with aortic valve replacement provides significantly better event-free survival than double valve replacement without a better actuarial survival. Reoperation rates are higher in the mitral valve repair and aortic valve replacement group, whereas thromboembolic complications were more in the double valve replacement group. Better event-free survival in patients undergoing mitral valve repair and aortic valve replacement still argues in favor of repair of the mitral valve whenever possible.

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