Mitral valve repair with aortic valve replacement is superior to double valve replacement A.Marc Gillinov, MD, Eugene H Blackstone, MD, Delos M Cosgrove,

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Presentation transcript:

Mitral valve repair with aortic valve replacement is superior to double valve replacement A.Marc Gillinov, MD, Eugene H Blackstone, MD, Delos M Cosgrove, MD, Jennifer White, MS, Paul Kerr, DO, Antonino Marullo, MD, Patrick M McCarthy, MD, Bruce W Lytle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 6, Pages 1372-1385 (June 2003) DOI: 10.1016/S0022-5223(02)73225-X

Figure 1 Time-related death after double valve surgery. A, Survival. Each symbol represents a death, positioned according to the Kaplan-Meier estimator. Open squares represent patients undergoing aortic valve replacement and mitral valve repair, and open circles represent patients undergoing double valve replacement. Vertical bars are asymmetric confidence limits for these estimates. Superimposed are parametric survival estimates and their confidence limits (solid line and dashed line, respectively). Numbers in parentheses represent patients traced beyond the indicated interval. B, Instantaneous risk (hazard function) of death. Solid line (point estimates) and coarse dashed lines (confidence limits) represent patients undergoing double valve replacement (replace), and solid line enclosed within fine dashed lines represents patients undergoing aortic valve replacement and mitral valve repair (repair). The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Figure 2 Survival after double valve surgery stratified according to double valve replacement (replace) or aortic valve replacement and mitral valve repair (repair). Depiction is as in Figure 1. A, Rheumatic disease; B, nonrheumatic disease. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Figure 3 Cumulative distribution of difference in percentage survival at 16 years between double valve replacement and aortic valve replacement and mitral valve repair, stratified according to rheumatic and nonrheumatic disease (see Analysis of Benefit under Patients and Methods). Only 1.7% of patients were predicted not to benefit from repair (negative portion of axis not shown). The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Figure 4 Survival after double valve surgery according to age at operation. Depiction is a nomogram from the multivariable analysis (Table 5) in which patient characteristics were entered as follows: NYHA Class II, left ventricular dysfunction less than grade 3, no important coronary disease, sinus rhythm, blood urea nitrogen 20 mg/dL, no kidney disease. A, Rheumatic disease; B, nonrheumatic disease. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Figure 5 Freedom from mitral valve replacement after aortic valve replacement and mitral valve repair. Patients are stratified according to rheumatic or nonrheumatic disease. Depiction is as in Figure 1. A, Freedom; B, hazard function. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Figure 6 Freedom from mitral valve reoperation after double valve surgery. Patients are stratified by both type of prosthesis used for mitral valve replacement and by cause if the mitral valve was repaired. Depiction is as in Figure 1, except that parametric confidence limits are suppressed for clarity. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)

Appendix Figure 1 Trends across time in management of patients with double valve disease. In these graphs, each closed circle represents yearly proportion; a solid line is continuous probability by univariable logistic regression. A, Proportion of patients in whom mitral valve was replaced; B, proportion of patients coming to operation with rheumatic mitral valve disease versus degenerative mitral valve disease. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 1372-1385DOI: (10.1016/S0022-5223(02)73225-X)