Key result
Preoperative left atrial pressures ≥30 mm Hg and fabric-covered valves were associated with higher hospital mortality, while high baseline cardiac pressures predicted lower long-term survival (P<0.05).
Cohort (n=100)
Elevated preoperative right and left heart pressures are significant predictors of poor short- and long-term survival following combined aortic and mitral valve replacement.
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May aid preoperative risk stratification in combined valve replacement; hypothesis-generating for targeted interventions in prospective studies.
From 1963 to 1971, aortic and mitral valves were replaced in 100 patients; 22 died in hospital. Follow-up in survivors is 100%. Catheterization was performed preoperatively in 99 patients and postoperatively in 85% of survivors. The influence of 19 preoperative potential risk factors on hospital mortality, postoperative symptomatic improvement, and long-term survival (assessed by monthly cohort-adjusted survival tables) was determined. Long-term survival was also assessed by comparing average values of the various risk factors in patients surviving 1, 2, and 3 years with values in patients who died during these intervals. In addition, changes induced by operation were studied 6 months postoperatively and their value in predicting subsequent longevity assessed. Significant ( P < 0.05) findings were: a higher hospital mortality in patients with left atrial pressures ≥30 mm Hg or with fabric-covered valves; less postoperative symptomatic improvement in older patients; lower long-term survival rate in men and in patients with high left atrial, right atrial, pulmonary arterial, or right ventricular end-diastolic pressures. A decrease in radiographic heart size or a New York Heart Association class I or II status 6 months postoperatively was associated with a favorable subsequent prognosis. Postoperative hemodynamic values did not predict subsequent survival.
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Melvin et al. (1973) conducted a cohort in Combined Aortic and Mitral Valve Replacement (n=100). Preoperative and postoperative prognostic factors was evaluated on Hospital mortality, postoperative symptomatic improvement, and long-term survival (p=<0.05). Preoperative left atrial pressures ≥30 mm Hg and fabric-covered valves were associated with higher hospital mortality, while high baseline cardiac pressures predicted lower long-term survival (P<0.05).
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