To Repair Or Replace The Mitral Valve In Triple Valve Surgery.

Introduction Triple valve surgery (TVS) is a complex and difficult surgery because of prolonged ischaemic times and technical issues. Furthermore, multiple valve replacement exposes the patients to a higher susceptibility to long-term major adverse valve-related events (MAVE) and cardiovascular and cerebrovascular events (MACCE). Objectives This study aimed to compare the surgical results of mitral valve replacement to mitral valve repair in TVS patients. Materials and Methods From January of 2000 to December of 2018, 113 TVS patients were treated in a single Centre. After exclusion of patients with other associated procedure and/or triple valve repair, 107 patients constituted the study population (aortic valve replacement plus mitral valve repair/replacement and tricuspid repair). Two groups were compared for short and long-term results: Group A - mitral valve repair (68 patients) and Group B - mitral valve replacement (45 patients). Cox proportional hazards models were used to analyse risk factors for late mortality and MACCE incidence. Kaplan-Meier methods were used to plot survival curves. The study population was compared to the general population (age and gender-matched, 1-sample log-rank test). Results Groups A and B was similar regarding age (66.0±10.7 vs. 63.4±8.6; p=0.164) and NYHA III/IV (73.5 % vs 84.4%; p=0.173), but rheumatic etiology was prevalent in group B (60.3% vs. 80.0%; p=0.028). Both cardiopulmonary bypass (93.6±15.1 vs.103.19±17.0 min; p=0.002) and cross-clamp times (62.9±12 vs. 71.2±13.2 min; p=0.001) were significantly higher in group B. No differences were found concerning major postoperative events (cardiogenic shock, acute myocardial infarction and stroke). Thirty-day mortality was similar in both groups (2.9% vs. 2.2%; p=0.817). No significant differences were found concerning 10-year survival (68.6±7.0% vs. 58.9±10.2%; p=0.302) as well as in MACCE incidence at 10 years (68.8±7.1% vs. 64.7±7.9%; p=0.151). Freedom from reoperation at 10 years was similar between two groups (93.1±3.9% vs. 92.3±4.4%; p=0.569). When compared to sex and age-matched general population patients of both groups had a lower long-term survival. Conclusions Triple valve surgery appears to confer satisfactory short and long-term results despite the surgical complexity. The choice of the mitral procedure did not affect survival and major adverse events at 10 years.