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Open Access 01-12-2021 | Aortic Valve Replacement | Research article

Considerations for prostheses choice in multiple valve surgery

Authors: Ahmad Poostizadeh, W. R. Eric Jamieson, A. Ian Munro, Robert T. Miyagishima, Hilton Ling, Guy J. Fradet, Michael T. Janusz, Lawrence H. Burr

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Objectives

The prosthesis type for multiple valve surgery (replacement of two or more diseased native or prosthetic valves, replacement of two diseased valves with repair/reconstruction of a third, or replacement of a single diseased valve with repair/reconstruction of a second valve) remains inadequately evaluated. The clinical performance of multiple valve surgery with bioprostheses (BP) and mechanical prostheses (MP) was assessed to compare patient survival and composites of valve-related complications.

Methods

Between 1975 and 2000, 1245 patients had multiple valve surgery (BP 785, mean age 62.0 ± 14.7 years; and MP 460, mean age 56.9 ± 12.9 years). There were 1712 procedures performed [BP 969(56.6%) and MP 743(43.4%). Concomitant coronary artery bypass (conCABG) was BP 206(21.3%) and MP 105(14.1%) (p = 0.0002). The cumulative follow-up was BP 5131 years and MP 3364 years. Independent predictors were determined for mortality, valve-related complications and composites of complications.

Results

Unadjusted patient survival at 12 years was BP 52.1 ± 2.1% and MP 54.8 ± 4.6% (p = 0.1127), while the age adjusted survival was BP 48.7 ± 2.3% and MP 54.4 ± 5.0%. The predictors of overall mortality were age [Hazard Ratio (HR) 1.051, p < 0.0001], previous valve (HR 1.366, p = 0.028) and conCABG (HR 1.27, p = 0.021). The actual freedom from valve-related mortality at 12 years was BP 85.6 ± 1.6% and MP 91.0 ± 1.6% (actuarial p = 0.0167). The predictors of valve-related mortality were valve type (BP > MP) (2.61, p = 0.001), age (HR 1.032, p = 0.0005) and previous valve (HR 12.61, p < 0.0001). The actual freedom from valve-related reoperation at 12 years was BP 60.8 ± 1.9% and MP85.6 ± 2.1% (actuarial p < 0.001). The predictors of valve-related reoperation were valve type (MP > BP) (HR 0.32, p < 0.0001), age (HR 0.99, p = 0.0001) and previous valve (HR 1.38, p = 0.008)

Conclusions

Overall survival (age adjusted) is differentiated by valve type over 10 and 12 years and valve-related mortality and valve-related reoperation favours the use of mechanical prostheses, overall for multiple valve surgery.

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Jamieson WRE. Modern cardiac valve devices—bioprostheses and mechanical prostheses: state of the art. J Card Surg. 1993;8(1):89–98.CrossRef

Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152–8.CrossRef

Oxenham H, Bloomfield P, Wheatley DJ, Lee RJ, Cunningham J, Prescott RJ, et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart. 2003;89:715–21.CrossRef

Kassai B, Gueyffier F, Cucherat M, Boissel JP. Comparison of bioprosthesis and mechanical valves, a meta-analysis of randomised clinical trials. Cardiovasc Surg. 2000;8(6):477–83.CrossRef

Hamamoto M, Bando K, Kobayashi J, Satoh T, Sasako Y, Niwaya K, et al. Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement. Ann Thorac Surg. 2003;75(1):28–33 (discussion 33–4).CrossRef

Kuwaki K, Kawaharada N, Morishita K, Koyanagi T, Osawa H, Maeda T, et al. Mitral valve repair versus replacement in simultaneous mitral and aortic valve surgery for rheumatic disease. Ann Thorac Surg. 2007;83(2):558–63.CrossRef

Szentpetery S, Rich JB, Azar H, Newton JR, Tenzer MM. Mitral valve repair combined with aortic valve replacement. J Heart Valve Dis. 1997;6(1):32–6.PubMed

Gillinov AM, Blackstone EH, Cosgrove DM 3rd, White J, Kerr P, Marullo A, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003;125(6):1372–87.CrossRef

Talwar S, Mathur A, Choudhary SK, Singh R, Kumar AS. Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement. Ann Thorac Surg. 2007;84:1219–25.CrossRef

10.

Ho HQ, Nguyen VP, Phan KP, Pham NV. Mitral valve repair with aortic valve replacement in rheumatic heart disease. Asian Cardiovasc Thorac Ann. 2004;12(4):341–5.CrossRef

11.

Munro AI, Jamieson WRE, Burr LH, Ling H, Miyagishima RT, Germann E. Comparison of porcine bioprostheses and mechanical prostheses in multiple valve replacement operations. Ann Thorac Surg. 1995;60(2 Suppl):S459–62 (discussion S463).CrossRef

12.

Jamieson WRE, Germann E, Fradet GJ, Lichtenstein SV, Miyagishima RT. Bioprostheses and mechanical prostheses predictors of performance. Asian Cardiovasc Thorac Ann. 2000;8:121–6.CrossRef

13.

Brown PS Jr, Roberts CS, McIntosh CL, Swain JA, Clark RE. Late results after triple-valve replacement with various substitute valves. Ann Thorac Surg. 1993;55(2):502–8.CrossRef

14.

Christenson JT, Velebit V, Maurice J, Simonet F, Schmuziger M. Valve reoperations—identification of risk factors and comparison with first-time operations. Thorac Cardiovasc Surgeon. 1994;42(6):325–9.CrossRef

15.

Caus T, Albertini JN, Chi Y, Collart F, Monties JR, Mesana T. Multiple valve replacement increases the risk of reoperation for structural degeneration of bioprostheses. J Heart Valve Dis. 1999;8(4):376–83.PubMed

16.

Caus T, Rouviere P, Collart F, Mouly-Bandini A, Monties JR, Mesana T. Late results of double-valve replacement with biologic or mechanical prostheses. Ann Thorac Surg. 2001;71(5 Suppl):S261–4.CrossRef

17.

Jamieson WRE, Munro AI, Miyagishima RT, Grunkemeier GL, Burr LH, Lichtenstein SV, et al. Multiple mechanical valve replacement surgery comparison of St. Jude Medical and CarboMedics prostheses. Eur J Cardio-Thorac Surg. 1998;13(2):151–9.CrossRef

18.

Jamieson WRE, Miyagishima RT, Tyers GF, Lichenstein SV, Munro AI, Burr LH. Bileaflet mechanical prostheses in mitral and multiple valve replacement surgery: influence of anticoagulant management on performance. Circulation. 1997;96(9 Suppl):134–39 (discussion II-140).

19.

Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg. 1996;62:932–5.CrossRef

20.

Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg. 2008;135(4):732–8.CrossRef

21.

Jamieson WRE, von Lipinski O, Miyagishima RT, Burr LH, Janusz MT, Ling H, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years for mitral valve replacement. J Thorac Cardiovasc Surg. 2005;129:1301–8.CrossRef

22.

Chan V, Jamieson WRE, Germann E, Chan F, Miyagishima RT, Burr LH, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement. J Thorac Cardiovasc Surg. 2006;131:1267–73.CrossRef

23.

Carrier M, Pellerin M, Bouchard D, Perrault LP, Cartier R, Hebert Y, et al. Long-term results with triple valve surgery. Ann Thorac Surg. 2002;73(1):44–7.CrossRef

24.

Alsoufi B, Rao V, Borger MA, Maganti M, Armstrong S, Feindel CM, Scully HE, David TE. Short- and long-term results of triple valve surgery in the modern era. Ann Thorac Surg. 2006;81:2172–7.CrossRef

25.

Leone A, Fortuna D, Gabbieri D, Nicolini F, Contini GA, Pigini F, Zussa C, De Palma R, Di Bartolomeo R, Pacini D, RERIC (Emilia Romagna Cardiac Surgery Registry) investigators. Triple valve surgery: results from a multicenter experience. J Cardiovasc Med. 2018;19:382–8.CrossRef

Title: Considerations for prostheses choice in multiple valve surgery
Authors: Ahmad Poostizadeh
W. R. Eric Jamieson
A. Ian Munro
Robert T. Miyagishima
Hilton Ling
Guy J. Fradet
Michael T. Janusz
Lawrence H. Burr
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Aortic Valve Replacement
Mitral Valve Replacement
Aortic Valve Replacement
Mitral Valve Replacement
Aortic Valve Replacement
Mitral Valve Replacement
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01631-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Considerations for prostheses choice in multiple valve surgery

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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