Repair of nonsevere rheumatic aortic valve disease during other valvular procedures: Is it safe?

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 115; no. 5; pp. 1130 - 1135
• Main Authors: Bernal, José M., Fernández-Vals, Mónica, Rabasa, José M., Gutiérrez-García, Francisco, Morales, Carlos, Revuelta, José M.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-05-1998; AATS/WTSA; Elsevier
• Subjects: Adolescent; Adult; Aged; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiopulmonary Bypass; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - mortality; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Rheumatic Heart Disease - mortality; Rheumatic Heart Disease - physiopathology; Rheumatic Heart Disease - surgery; Safety; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - surgery; Human; Corrective surgery; Prognosis; Treatment efficiency; Diseases of the osteoarticular system; Cardiovascular disease; Inflammatory joint disease; Aortic valve disease; Long term; Functional recovery; Treatment; Combined surgery; Heart disease; Complication; Severity score; Mitral valve disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(98)70413-1

Objective: To investigate the long-term performance of aortic valve repair, we analyzed the results obtained in a 22-year period in patients who underwent repair of nonsevere rheumatic aortic valve disease during other valvular procedures.
Methods: Fifty-three patients (mean 40 ± 11.6 years of age) with predominant rheumatic mitral valve disease had concomitant aortic valve disease in association with serious tricuspid valve disease in 25 of them. Preoperatively, aortic valve disease was considered moderate in 47.2% of the patients and mild in 52.8%. All patients underwent reparative techniques of the aortic valve (free edge unrolling, 44; subcommissural annuloplasty, 40; commissurotomy, 36) at the time of mitral or mitrotricuspid valve surgery. The completeness of follow-up during the closing interval was 100%, with a mean follow-up of 18.8 years (range 8 to 22.5 years).
Results: Hospital mortality rate was 7.5%. Of 49 surviving patients, 26 (53.1%) died during late follow-up. The actuarial survival curve including hospital mortality was 35.4% ± 8.7% at 22 years. For patients who underwent mitral and aortic valve surgery, the actuarial survival curve at 22 years was 32.3% ± 13%, whereas for patients who had a triple-valve operation the survival was 37.0% ± 10.1% (
p = 0.07). Twenty-five patients underwent an aortic prosthetic valve replacement. Actuarial free from aortic structural deterioration and valve-related complications at 22 years was 25.3% ± 9.3% and 12.7% ± 4.8%, respectively.
Conclusions: Long-term functional results of reparative procedures of nonsevere aortic valve disease in patients with predominant rheumatic mitral valve disease have been inadequate at 22 years of follow-up. According to these data, conservative operations for rheumatic aortic valve disease do not seem appropriate. (J Thorac Cardiovasc Surg 1998;115:1130-5)