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

B. J. Gersh, Hartzell 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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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
StatePublished - 1985

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Mortality
Endocarditis
Survival
Thromboembolism
Sudden Death
Embolism
Reoperation
Survivors
Multivariate Analysis
Heart Failure
Myocardial Infarction
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Gersh, B. J., Schaff, H. V., Vatterott, P. J., Danielson, G. K., Orszulak, T. A., Piehler, J. M., ... McGoon, D. C. (1985). Results of triple valve replacement in 91 patients: Perioperative mortality and long-term follow-up. Circulation, 72(1), 130-137.

Results of triple valve replacement in 91 patients : Perioperative mortality and long-term follow-up. / Gersh, B. J.; Schaff, Hartzell V; Vatterott, P. J.; Danielson, G. K.; Orszulak, T. A.; Piehler, J. M.; Puga, F. J.; Pluth, J. R.; McGoon, D. C.

In: Circulation, Vol. 72, No. 1, 1985, p. 130-137.

Research output: Contribution to journalArticle

Gersh, BJ, Schaff, HV, Vatterott, PJ, Danielson, GK, Orszulak, TA, Piehler, JM, Puga, FJ, Pluth, JR & McGoon, DC 1985, 'Results of triple valve replacement in 91 patients: Perioperative mortality and long-term follow-up', Circulation, vol. 72, no. 1, pp. 130-137.
Gersh BJ, Schaff HV, Vatterott PJ, Danielson GK, Orszulak TA, Piehler JM et al. Results of triple valve replacement in 91 patients: Perioperative mortality and long-term follow-up. Circulation. 1985;72(1):130-137.
Gersh, B. J. ; Schaff, Hartzell V ; Vatterott, P. J. ; Danielson, G. K. ; Orszulak, T. A. ; Piehler, J. M. ; Puga, F. J. ; Pluth, J. R. ; McGoon, D. C. / Results of triple valve replacement in 91 patients : Perioperative mortality and long-term follow-up. In: Circulation. 1985 ; Vol. 72, No. 1. pp. 130-137.
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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.",
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AU - Gersh, B. J.

AU - Schaff, Hartzell V

AU - Vatterott, P. J.

AU - Danielson, G. K.

AU - Orszulak, T. A.

AU - Piehler, J. M.

AU - Puga, F. J.

AU - Pluth, J. R.

AU - McGoon, D. C.

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N2 - 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.

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