Abstract
Introduction
In the context of double-valve surgery for elderly high-risk patients involving both the aortic and mitral valves, a clinically significant problem has been that no clear criteria or surgical strategies have been reported for the selection of mitral valve plasty (MVP) or mitral valve replacement (MVR) for mitral valve disease management during surgical aortic valve replacement (SAVR) to achieve better clinical outcomes. This study investigated valve durability and survival using our surgical strategy for mitral valve disease with concomitant SAVR in elderly patients.
Methods
Eighty-six patients aged > 65 years (mean 75 years) who underwent a double-valve procedure for mitral valve surgery with concomitant SAVR from 2010 to 2022 were reviewed. Our surgical strategy for mitral valve disease with concomitant SAVR for the elderly patients was as follows: MVP was selected for patients in whom mitral valve disease was expected to be controlled with simple surgical procedures (n = 47), otherwise MVR was selected (n = 39).
Results
The hospital mortality rate was 8% (n = 7). The mean follow-up was 4.9 (0–12.3) years. And the 10-year survival rate was 62%. The 10-year freedom from aortic valve reoperation rate was 95%. No mitral valve reintervention was performed during follow-up. Echocardiographic follow-up demonstrated freedom from at least moderate mitral regurgitation in 86% of cases at 10 years.
Conclusion
In double-valve surgery for elderly high-risk patients, appropriate selection of the mitral valve procedure with concomitant SAVR provided better early and long-term survival and valve durability. This surgical strategy may be beneficial in elderly patients with combined aortic and mitral valve disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The deidentified participant data will be shared.
References
Maisano F, Viganò G, Calabrese C, Taramasso M, Denti P, Blasio A, et al. Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation. Eur J Cardiothorac Surg. 2009;36:261–6.
Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, et al. Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short- and Long-Term Outcomes in a Propensity-Matched Cohort. J Am Heart Assoc. 2016;5: e003605.
Shang X, Lu R, Liu M, Xiao S, Dong N. Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis. J Thorac Dis. 2017;9:3045–51.
Coyan GN, Aranda-Michel E, Sultan I, Gleason TG, Navid F, Chu D, et al. Outcomes of mitral valve surgery during concomitant aortic valve replacement. J Card Surg. 2018;33:706–15.
Arshad HB, Minhas AMK, Khan SU, Nasir K, Rao N, Thacker S, et al. National trends and outcomes of surgical aortic valve replacement with concomitant mitral valve surgery. Cardiovasc Revasc Med. 2022;40:13–9.
Coutinho GF, Correia PM, Antunes MJ. Concomitant aortic and mitral surgery: to replace or repair the mitral valve? J Thorac Cardiovasc Surg. 2014;148:1386–92.
Thourani VH, Suri RM, Rankin JS, He X, O’Brien SM, Badhwar V, et al. Does mitral valve repair offer an advantage over replacement in patients undergoing aortic valve replacement? Ann Thorac Surg. 2014;98:598–603.
Urban M, Pirk J, Turek D, Netuka I. In patients with concomitant aortic and mitral valve disease is aortic valve replacement with mitral valve repair superior to double valve replacement? Interact Cardiovasc Thorac Surg. 2011;12:238–42.
Lehmann S, Merk DR, Etz CD, Oberbach A, Uhlemann M, Emrich F, et al. Porcine xenograft for aortic, mitral and double valve replacement: long-term results of 2544 consecutive patients. Eur J Cardiothorac Surg. 2016;49:1150–6.
Guo H, Lu C, Huang H, Xie B, Liu J, Zheng S, et al. Long-term clinical outcomes of the Carpentier-Edwards Perimount pericardial bioprosthesis in Chinese patients with single or multiple valve replacement in aortic, mitral, or tricuspid positions. Cardiology. 2017;138:97–106.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57-185.
Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:814–22.
Patra C, Chamaiah Gatti P, Panigrahi A. Morbidity After cardiac surgery under cardiopulmonary bypass and associated factors: A retrospective observational study. Indian Heart J. 2019;71:350–5.
Chalmers J, Pullan M, Mediratta N, Poullis M. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg. 2014;19:21–6.
Bhukal I, Solanki SL, Ramaswamy S, Yaddanapudi LN, Jain A, Kumar P. Perioperative predictors of morbidity and mortality following cardiac surgery under cardiopulmonary bypass. Saudi J Anaesth. 2012;6:242–7.
Uchino G, Murakami H, Mukohara N, Tanaka H, Nomura Y, Miyahara S et al. Modes of the bioprosthetic valve failure of the porcine and pericardial valves in the mitral position. Eur J Cardiothorac Surg 2021:ezab506.
Ram E, Schwammenthal E, Cohen H, Kogan A, Peled Y, Sternik L, et al. Outcomes of degenerative mitral valve repair surgery for anterior, posterior, and bileaflet pathology. Ann Thorac Surg. 2020;110:934–42.
Enta Y, Nakamura M. Transcatheter mitral valve replacement. J Cardiol. 2021;77:555–64.
Zubarevich A, Szczechowicz M, Arjomandi Rad A, Vardanyan R, Marx P, Lind A, et al. Mitral surgical redo versus transapical transcatheter mitral valve implantation. PLoS ONE. 2021;16: e0256569.
Gandhi S, Natarajan MK, Chu V, Dokainish H, Mehta S, Velianou JL. MitraClip and transcatheter aortic valve replacement in a patient with recurrent heart failure. Circ Cardiovasc Interv. 2017;10: e005312.
Acknowledgements
We thank Dr. Alison Sherwin, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Funding
The authors declare that they received no financial support pertaining to this study.
Author information
Authors and Affiliations
Contributions
KH wrote the draft of the manuscript. TO revised the article. All authors (KH, TO, NS, TN, TK, TM) read and approved the final manuscript.
Corresponding author
Ethics declarations
Informed consent
Obtained from the patient.
Conflict of interest
The authors declare that there is no conflict of interest.
Ethics committee approval
The present study was approved by institutional ethics committee of Sakurabashi Wantanabe Hospital vide reference number 22–34; Date of approval 26, September, 2022.
Human and animal Rights statement
This manuscript reports on experiments on human subjects. The procedures were followed in accordance with the “Declaration of Helsinki” and the ethical standards of the responsible committee on human experimentation.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Handa, K., Ohata, T., Sekiya, N. et al. Procedural selection strategy and clinical outcomes in mitral valve surgery with concomitant aortic valve replacement in elderly patients. Indian J Thorac Cardiovasc Surg 40, 159–170 (2024). https://doi.org/10.1007/s12055-023-01626-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-023-01626-0