Abstract
Objectives
The objectives of this study were to examine operative and long-term results of combined
aortic and mitral valve replacement when reconstruction of the fibrous skeleton of
the heart is needed because of calcification, abscess, previous operations, or patient-prosthesis
mismatch.
Methods
From 1985 to 2020, 182 consecutive patients underwent combined aortic and mitral valve
replacement with reconstruction of the intervalvular fibrous skeleton in all cases
and also the posterior mitral annulus in 63 patients. Bovine pericardium or Dacron
grafts were used for the reconstructions. Median follow-up was 7.5 (interquartile
range, 2.1-12.6) years and 98% complete.
Results
Patient mean age was 62 years; 69% had 1 or more previous valve operations, and 92%
were functional class III or IV. The indications for reconstruction were extensive
calcification of the fibrous skeleton in 34%, abscess in 13%, tissue damage secondary
to previous operations in 39%, and patient-prosthesis mismatch of the mitral valve
in 13%. Bovine pericardium was used in two-thirds of cases and Dacron grafts in one-third.
Operative mortality was 13.2% and postoperative complications were common. Survival
at 1, 10, and 20 years was 81.8%, 51.1%, and 23.7%, respectively. Fourteen patients
required reoperation and 3 transcatheter interventions. The cumulative probability
of reinterventions at 1, 10, and 20 years were 3.3%, 5.8%, and 9.1%, respectively.
Most patients experienced symptomatic improvement postoperatively.
Conclusions
Reconstructions of the fibrous skeleton of the heart are associated with high operative
mortality but the long-term results are satisfactory because most patients would not
have survived without surgical intervention.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
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Article info
Publication history
Published online: September 22, 2021
Accepted:
September 2,
2021
Received in revised form:
July 25,
2021
Received:
May 30,
2021
Footnotes
This project was supported by a donation from Leo and Marisa Crispino to the Cardiovascular Research Fund of Toronto General Hospital.
The editorial review of this paper was handled by Associate Editor Pavan Atluri, MD.
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: U can't touch thisThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 5
- PreviewMany times in his 1990 hit of the same name, MC Hammer intoned: “U can't touch this!”1 Readers might agree while reviewing Tirone David’s 35-year experience with aortic-mitral valve replacement and reconstruction of the intravalvular fibrous body.2 David and colleagues,3 who first described the procedure in 1997, detail the various iterations of the procedure, provide illustrations, and report 1-, 10-, and 20-year survival of 81.8%, 51.1%, and 23.7%, respectively.
- Full-Text
- Preview
- Commentary: Evolution of surgical technique in the hands of an expertThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 5
- PreviewDavid and colleagues1 from Toronto provide an update on the team's single-surgeon series of patients with double valve (aortic and mitral) replacement and reconstruction of the fibrous skeleton of the heart. The approach used, which has been dubbed elsewhere “commando” or “UFO” due to a complexity that takes most surgeons out of their comfort zone, has been perfected over the years by Dr David. His early series was described in 1997 and included 43 patients.2 A follow-up series was published in 2005 and included 73 patients.
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- Preview
