Abstract
Introduction: The Euro Heart Survey on Valvular Heart Disease reports that approximately 17% of patients with valvular heart disease are affected by two or more valves simultaneously. The most common combination requiring simultaneous surgery is aortic and mitral valve surgery. This procedure remains highly demanding for all surgical teams, even today.
The primary focus of this study is to present, for the first time, the early postoperative results of simultaneous aortic and mitral valve surgery at our clinic. We aim to compare our outcomes with those reported by other cardiovascular surgical centers, with a strong emphasis on patient well-being and survival rates.
Materials and Methods: This is a retrospective study that included adult patients who underwent simultaneous aortic and mitral valve surgery between January 2007 and December 2023 at the Cardiac Surgery Service, UHC "Mother Theresa", Tirana, Albania. The Data collection was performed using operating room registers and hospital medical records. Demographic, clinical, and non-clinical data were gathered for each patient before, during, and after the surgery.
Results: This study included 121 patients, comprising 55 males (45.5%) and 66 females (55.5%). The average age of the study population was 56.41 ± 10.35 years. Most patients underwent elective surgery (111, 91.7%), while 10 (8.3%) were urgent surgical cases. Aortic valve regurgitation was the most prevalent pathology, affecting 58 patients (47.9%). The hospital mortality rate was 6.6% (8 patients). The most common postoperative complications included low cardiac output (17.4%), conduction disturbances requiring permanent pacemaker implantation (8.3%), new-onset atrial fibrillation (8.3%), and postoperative hemorrhage (5.8%).
Conclusions: Our study on simultaneous aortic and mitral valve surgery at our clinic has demonstrated satisfactory early outcomes, including low rates of early mortality and major postoperative complications. These findings offer valuable insights for the medical community and contribute to the ongoing discourse on cardiac surgery outcomes.
References
Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24(13):1231–1243.
Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 2011;91(3):677–684.
Kirklin/Barratt-Boyes. Cardiac Surgery Third Edition, Volume 1, Combined Aortic and Mitral Valve Disease with or without Tricuspid Valve Disease,657-671.
Husso A, Riekkinen T, Rissanen A, Ollila J, Valtola A. Combined Mitral and Aortic Valve Surgery: 17-year Experience in a Single Center. Scand J Surg 2021 Jan 18;110(4):533–541.
Arshad H, Minhas A, Khan S, Nasir K, Rao N, Thacker S, Butt S, Faza N, Little S, von Ballmoos, Kleiman N, Reardon M, Kapadia S, Goel S. National Trends and Outcomes of Surgical Aortic Valve Replacement With Concomitant Mitral Valve Surgery. Cardiovascular Revascularization Medicine. Volume 40, July 2022, Pages 13-19.
Egger M, Gahl B, Koechlin L, Schömig L, Matt P, Reuthebuch O, Eckstein F, Grapow M. Outcome of patients with double valve surgery between 2009 and 2018 at University Hospital Basel, Switzerland. Journal of Cardiothoracic Surgery (2022),17:152 DOI: 10.1186/s13019-022-01904-9
Gillinov AM, Blackstone EH, Cosgrove DM III, White J, Kerr P, Marullo A, McCarthy PM, Lytle BW. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003; 25: 1372–1387.
Urban M, Pirk J, Szarszoi O, Skalsky I, Maly J, Netuka I. Mitral valve repair versus replacement in simultaneous aortic and mitral valve surgery. exp Clin Cardiol 2013;18(1):22-26.
Leavitt B, Baribeau Y, DiScipio A, Ross C, MS, Quinn R, Olmstead E. Outcomes of Patients Undergoing Concomitant Aortic and Mitral Valve Surgery in Northern New England. Circulation, Volume 120, Number 11_suppl_1
Mueller X, Tevaearai H, Stumpe F, Fischer A, Hurni M, Ruchat P, Segesser L. Long-term results of mitral-aortic valve operations. The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 6, June 1998, Pages 1298-1309
Moskowitz G, Hong KN, MD, Giustino G, Gillinov AM, Ailawadi G, DeRose JJ, Iribarne A, Moskowitz AJ, Gelijns AC, Egorova NN Incidence and Risk Factors forPermanent Pacemaker ImplantationFollowing Mitral or Aortic Valve Surgery. J Am Coll Cardiol. 2019 November 26; 74(21): 2607–2620. doi:10.1016/j.jacc.2019.08.1064.
Helmers MR, Shin M, Iyengar A, Arguelles GR, Mays J, Han JJ, Patrick W, Altshuler P, Hargrove WC, Atlur P. Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes. European Journal of Cardio-Thoracic Surgery 60 (2021) 140–147.
Hannan EL, Racz MJ, Jones RH, Gold JP, Ryan TJ, Hafner JP, Isom OW. Predictors of mortality for patients undergoing cardiac valve replacements in New York State. Ann Thorac Surg. 2000; 70: 1212–1218.
Galloway AC, Grossi EA, Baumann FG, LaMendola CL, Crooke GA, Harris LJ, Colvin SB, Spencer FC. Multiple Valve Operation for Advanced Valvular Heart Disease: Results and Risk Factors in 513 Patients. J Am Coll Cardiol. 1992; 19: 725–732.
Birkmeyer NJ, Marrin CA, Morton JR, Leavitt BJ, Lahey SJ, Charlesworth DC, Hernandez F, Olmstead EM, O'Connor GT. Decreasing mortality for aortic and mitral valve surgery in Northern New England. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg. 2000; 70: 432–437.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC focused update of the 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 Clinical Practice Guidelines. Circulation. 2017;135:e1159–e1195. DOI: 10.1161/CIR.0000000000000503.
Coutinho GF, Correia PM, Antunes MJ. Concomitant aortic and mitral surgery: To replace or repair the mitral valve? J Thorac Cardiovasc Surg. 2014;148(4):1386-1392.

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