Triple-Valve Procedures: Impact of Risk Factors on Midterm in a Rheumatic Population

Abstract

We aimed to determine the influence of preoperative, intraoperative, and postoperative variables on short and midterm results in patients undergoing triple-valve surgery. Between September 1989 and December 2003, 157 patients underwent triple-valve surgery with mechanical prosthetic valves. Preoperative, operative, and postoperative data were retrospectively analyzed and risk factors affecting hospital mortality and short and midterm survival were evaluated. The hospital mortality was 2.5%. Multivariate analysis revealed that New York Heart Association functional class IV, low left ventricular ejection fraction (< 0.35) and increased left ventricular end diastolic diameter (> 50 mm Hg) were associated with increased short and midterm mortality. The freedom rate from reoperation and thromboembolic complications at 5 years were 93% +/- 4% and 81% +/- 7%, respectively. In echocardiographic assessments, significant decrease in left ventricular end-diastolic and end-systolic diameters (53.1 +/- 8.3 vs 50.1 +/- 7.1, p = 0.002 and 35.3 +/- 7.4 vs 32.6 +/- 7.2, p = 0.002) was observed. Triple-valve surgery offers satisfactory short and midterm results and prevents ventricular dilatation. Mortality significantly decreases if surgery is performed before left ventricle functions deteriorate.