Outcome of patients with double valve surgery between 2009 and 2018 at University Hospital Basel, Switzerland.
Aortic Valve
/ surgery
Endocarditis
/ etiology
Heart Valve Diseases
/ complications
Heart Valve Prosthesis
/ adverse effects
Heart Valve Prosthesis Implantation
/ adverse effects
Hospitals
Humans
Retrospective Studies
Stroke Volume
Switzerland
/ epidemiology
Treatment Outcome
Ventricular Function, Left
Double valve replacement
Mitral valve repair
Mitral valve replacement
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
13 Jun 2022
13 Jun 2022
Historique:
received:
07
12
2021
accepted:
28
05
2022
entrez:
13
6
2022
pubmed:
14
6
2022
medline:
16
6
2022
Statut:
epublish
Résumé
In isolated mitral valve regurgitation general consensus on surgery is to favor repair over replacement excluding rheumatic etiology or endocarditis. If concomitant aortic valve replacement is performed however, clinical evidence is more ambiguous and no explicit guidelines exist on the choice of mitral valve treatment. Both, double valve replacement (DVR) and aortic valve replacement in combination with concomitant mitral valve repair (AVR + MVP) have been proven to be feasible procedures. In our single-center, retrospective, observational cohort study, we compared the outcome of these two surgical techniques focusing on mortality and morbidity. 89 patients underwent DVR (n = 41) or AVR + MVP (n = 48) in our institution between 2009 and 2018. Follow-up data was collected using electronic patient records, by contacting treating physicians and by telephone interviews. We used the Kaplan-Meier method to analyze mortality during follow-up and Cox regression to investigate potential predictors of mortality. During a median follow-up duration of 4.5 [IQR 2.9 to 6.1] years, there was no significant difference in mortality between both cohorts. Thirty days mortality was 6.3% in the DVR and 7% in the AVR + MVP cohort. Overall mortality amounted to 17% for DVR and 23% for AVR + MVP. DVR was the preferred procedure for valve disease of rheumatic etiology and for endocarditis, while in degenerative valves AVR + MVP was predominant. More biological valves were used in the AVR + MVP cohort (p < 0.001) and more mechanical valves were implanted in the DVR cohort. The rate of rehospitalization, deterioration of left ventricular ejection fraction and postoperative complications were equally distributed among the two cohorts. Our data analysis showed that both DVR and AVR + MVP are safe and feasible options for double valve surgery. Based on our findings we could not prove superiority of one surgical technique over the other. Choosing the appropriate procedure for the patient should be influenced by valve etiology, patients' comorbidities and the surgeons' experience. This was a retrospectively registered trial, registered on April 1st 2018, ClinicalTrials.gov Identifier: NCT03667274.
Sections du résumé
BACKGROUND
BACKGROUND
In isolated mitral valve regurgitation general consensus on surgery is to favor repair over replacement excluding rheumatic etiology or endocarditis. If concomitant aortic valve replacement is performed however, clinical evidence is more ambiguous and no explicit guidelines exist on the choice of mitral valve treatment. Both, double valve replacement (DVR) and aortic valve replacement in combination with concomitant mitral valve repair (AVR + MVP) have been proven to be feasible procedures. In our single-center, retrospective, observational cohort study, we compared the outcome of these two surgical techniques focusing on mortality and morbidity.
METHODS
METHODS
89 patients underwent DVR (n = 41) or AVR + MVP (n = 48) in our institution between 2009 and 2018. Follow-up data was collected using electronic patient records, by contacting treating physicians and by telephone interviews. We used the Kaplan-Meier method to analyze mortality during follow-up and Cox regression to investigate potential predictors of mortality.
RESULTS
RESULTS
During a median follow-up duration of 4.5 [IQR 2.9 to 6.1] years, there was no significant difference in mortality between both cohorts. Thirty days mortality was 6.3% in the DVR and 7% in the AVR + MVP cohort. Overall mortality amounted to 17% for DVR and 23% for AVR + MVP. DVR was the preferred procedure for valve disease of rheumatic etiology and for endocarditis, while in degenerative valves AVR + MVP was predominant. More biological valves were used in the AVR + MVP cohort (p < 0.001) and more mechanical valves were implanted in the DVR cohort. The rate of rehospitalization, deterioration of left ventricular ejection fraction and postoperative complications were equally distributed among the two cohorts.
CONCLUSION
CONCLUSIONS
Our data analysis showed that both DVR and AVR + MVP are safe and feasible options for double valve surgery. Based on our findings we could not prove superiority of one surgical technique over the other. Choosing the appropriate procedure for the patient should be influenced by valve etiology, patients' comorbidities and the surgeons' experience.
TRIAL REGISTRATION
BACKGROUND
This was a retrospectively registered trial, registered on April 1st 2018, ClinicalTrials.gov Identifier: NCT03667274.
Identifiants
pubmed: 35698233
doi: 10.1186/s13019-022-01904-9
pii: 10.1186/s13019-022-01904-9
pmc: PMC9190140
doi:
Banques de données
ClinicalTrials.gov
['NCT03667274']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
152Informations de copyright
© 2022. The Author(s).
Références
Circ Cardiovasc Imaging. 2018 Aug;11(8):e007862
pubmed: 30354497
Circulation. 1995 Feb 15;91(4):1022-8
pubmed: 7850937
Circulation. 2009 Sep 15;120(11 Suppl):S155-62
pubmed: 19752361
J Thorac Cardiovasc Surg. 2015 Jun;149(6):1614-9
pubmed: 26060006
Eur J Cardiothorac Surg. 1999 Jun;15(6):816-22; discussion 822-3
pubmed: 10431864
Ann Thorac Surg. 2003 Jan;75(1):28-33; discussion 33-4
pubmed: 12537188
J Thorac Cardiovasc Surg. 2003 Jun;125(6):1372-87
pubmed: 12830057
J Thorac Cardiovasc Surg. 2014 Oct;148(4):1386-1392.e1
pubmed: 24507982
Ann Thorac Surg. 1999 Apr;67(4):943-51
pubmed: 10320233
Eur J Cardiothorac Surg. 2018 Dec 1;54(6):1085-1092
pubmed: 29800093
J Am Coll Cardiol. 2017 Jul 11;70(2):252-289
pubmed: 28315732
Ann Thorac Surg. 1994 Mar;57(3):697-702; discussion 702-3
pubmed: 8147643
Acta Cardiol. 2016 Feb;71(1):3-6
pubmed: 26853247
Ann Thorac Surg. 2007 Oct;84(4):1219-25
pubmed: 17888973
Ann Thorac Surg. 1993 Mar;55(3):631-40
pubmed: 8452425
J Cardiothorac Surg. 2007 May 24;2:24
pubmed: 17524142
Ann Thorac Surg. 2008 Apr;85(4):1490-5
pubmed: 18355567