RESUMO
In this retrospective study with long-term follow-up, we extracted a cohort of 94 patients underwent double-valve replacement [mitral valve replacement [MVR] and aortic valve replacement [AVR]] between 1995 and 1999. All of these 94 patients were operated on by mechanical bileaflet low profile prostheses, either St Judes or carbomedics depending upon the availability of valve at the time of surgery. The largely predominant etiology was rheumatic heart disease [97.87%]. Patients were classified as New York Heart Association class III/IV in 60% of cases. Patients were investigated mainly by echocaridiography, with a mean left ventricular ejection fraction of 54.7 +/- 12.2, and the pulmonary artery pressure was elevated with a mean value of 40.0 +/- 11.6 mm Hg. The diameter of the implanted valve was 21.7 +/- 2.3 mm in the aortic position and 29 +/- 2.3 in the mitral position. The updated follow-up in 2005 till 2008 was performed by a patient questionnaire, and the patient's attending physician or cardiologist was also contacted. Five patients were lost to follow-up in this updated survey, with a mean follow-up of 10 years. The mean length of stay in intensive care was 29.74 +/- 13.27 hours, whereas mean hospital stay was 12.2 +/- 3 days. The operative mortality [<30 days] was 9.08%. the leading cause of operative mortality was a low cardiac output syndrome [20%] responsible for a high operative mortality. On follow-up the majority of patients were classified as New York Heart Association class I or II, 80% of patients considered that they had a normal quality of life, and 20% reported a less or very limited quality of life. Twenty- four patients died and 5 were lost to follow-up, the early mortality rate [<1 month] was 9%, and 5- and 10- year survival rates were 81% and 64%, respectively. The mortality rate remained stable during the entire follow-up period [5%patient-year]. Most patients [n=9] died of cardiac causes; heart failure and sudden, unexpected death were the most frequent causes of cardiac death. The long- term results of double mechanical valve replacements are satisfactory in terms of both survival and quality of life with modern surgical perioperative treatment and durable bileaflet mechanical prostheses that have excellent hemodynamic performance