Outcomes of Different Mitral Valve Approaches Combined with Aortic Valve Replacement in Patients with Degenerative Valve Disease

Abstract

Introduction: The objective of this cohort study was to analyze the long-term relative survival of degenerative valve disease (DVD) patients who underwent mitral valve repair (MVP) or replacement and aortic valve replacement (AVR). Methods: A total of 146 patients underwent double valve replacement (DVR) or MVP+AVR at four institutions between 2016 and 2022. Kaplan–Meier method was applied to analyze survival rate. The potential predictors of mortality were investigated by Cox regression. Results: Of 146 patients, 62 underwent MVP+AVR, and 84 underwent DVR. The thirty-day mortality rate was 4.76% in the DVR cohort and 1.61% in the MVP+AVR cohort. At baseline, there were differences in age (63.39 ± 8.01 vs. 58.46 ± 9.92, p = 0.012), proportions of male patients (51.61% vs. 72.62, p = 0.014), smoking history (45.16% vs. 28.57%, p = 0.039). More biological valves were applied in the MVP+AVR cohort (77.42% vs. 47.62%, p < 0.001). There was no significant difference in mortality between the cohorts (1339.5 [Interquartile range (IQR), 1021.25–1876.75] vs. 1026.00 [IQR, 679.50–1674.00], p = 0.252). The overall mortality rate was 16.67% for DVR and 6.45% for MVP+AVR. Mechanical valve replacement (hazard ratio (HR) = 3.7, 95% confidence interval (CI): 1.0–12.0, p = 0.029) was increased the risk of postoperative mortality. Conclusion: Although the superiority of MVP+AVR was not verified with statistical significance in our cohort, we believe that MVP+AVR should be the preferred strategy for treating most DVD patient because it is associated with higher survival rates during follow-up.