Results of triple valve replacement in 91 patients: Perioperative mortality and long-term follow-up

B. J. Gersh, H. V. Schaff, P. J. Vatterott, G. K. Danielson, T. A. Orszulak, J. M. Piehler, F. J. Puga, J. R. Pluth, D. C. McGoon

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34 Scopus citations

Abstract

Between 1961 and 1984, 91 patients underwent simultaneously triple valve replacement at the Mayo Clinic. Of the 273 prosthetic valves used, 77% were Starr-Edwards. Perioperative (30 day) mortality was 24% to 27% between 1962 and 1974 and 7% between 1975 and 1983 (p = .17). In patients with NYHA class IV symptoms, perioperative mortality was 44%, and in those with milder symptoms, it was 8% (p<.0001). The median follow-up was 7.5 years (range, 6 weeks to 20 years). Cumulative survival, which was calculated taking into consideration perioperative mortality, was 64% at 1 year, 55% at 5 years, 40% at 10 years, and 25% at 15 years. Multivariate analysis identified preoperative functional class and age as predictors of the survival. Among causes of the late mortality were sudden death in 32.5%, congestive heart failure in 15%, thromboembolism in 12.5%, prosthetic valve dysfunction in 7.5%, and infective endocarditis in 5%. Late complications included systemic emboli in 42% (embolic rate, 12.3 events per 100 patient-years), bleeding in 22%, myocardial infarction in 16%, and infective endocarditis in 6%. Eight patients required reoperation for prosthetic valve dysfunction, and 12 patients had permanent pacemakers. Of the 29 patients still alive, 79% are in NYHA class I or II. In summary, perioperative mortality after triple valve replacement appears to be declining; long-term survival in 30 day survivors is similar to that after single valve replacement and excellent symptomatic improvement can be obtained, although morbidity is high.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalCirculation
Volume72
Issue number1
DOIs
StatePublished - Jan 1 1985

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Gersh, B. J., Schaff, H. V., Vatterott, P. J., Danielson, G. K., Orszulak, T. A., Piehler, J. M., Puga, F. J., Pluth, J. R., & McGoon, D. C. (1985). Results of triple valve replacement in 91 patients: Perioperative mortality and long-term follow-up. Circulation, 72(1), 130-137. https://doi.org/10.1161/01.CIR.72.1.130