Single-valve vs. multivalve surgery: a contemporary comparative analysis of clinicas characteristics and outcomes

Abstract Introduction Multivalve surgery, which involves intervention in 2 or more valves, is associated with higher surgical mortality and reduced long-term survival compared to single-valve surgery. However, studies are outdated, heterogeneous and poorly representative of underdeveloped countries, where rheumatic diseases are prevalent. Objectives To perform a comparative analysis of clinical and epidemiological data, as well as surgical outcomes between patients undergoing single and multivalve surgery. Methods Patients who underwent native valve surgery were categorized into single and multivalve surgery. A comparative analysis was performed to access clinical characteristics, etiology and 30-day outcomes. Predictors of 30-day cardiovascular mortality were evaluated. Results In a contemporary cohort of 645 heart valve surgery cases, 564 patients underwent single-valve and 81 underwent multivalve surgery. There was no difference regarding age, sex and most comorbidities between groups (Table 1). However, single-valve group had lower incidence of atrial fibrillation (AF), higher incidence of coronary disease and greater creatinine clearance. Echocardiogram also showed differences: systolic pulmonary arterial pressure was higher in multivalve group, as well as left chamber diameters. Otherwise, left ventricle ejection fraction (LVEF) was similar between groups. Regarding etiology, rheumatic disease predominates in mitral stenosis (94%) and regurgitation (36.2%), while degenerative disease was more prevalent in aortic stenosis (77.9%) and regurgitation (36.2%). There was a notable prevalence of rheumatic patients, especially in the multivalve group (Table 1). In the single-valve group, aortic valve replacement (51.8%) and mitral valve replacement (33.2%) predominated, while in the multivalve group, aortic valve replacement occurred in 59.3%, mitral valve replacement in 46.9%, mitral valve repair in 48.1% and tricuspid valve repair in 21.0%. As expected, cardiopulmonary bypass time and cross-clamp time were longer in the multivalve group. There was no difference in terms of overall mortality and 30-day outcomes (Table 2). In the logistic regression analysis, multivalve surgery was not a predictor of 30-day mortality (HR:1.578, 95%CI 0.855-2.915, p=0.145). Predictors were: diabetes (HR:2.247, 95%CI 1.232-4.096, p=0.008), previous cardiac surgery (OR:2.094, 95%CI 1.085-4.041, p=0.028), previous AF (OR: 1.938, 95%CI 1.081-3.472, p=0.026), LVEF (OR: 0.962, 95%CI 0.942-0.982, p=0.001), hemoglobin (OR:0.805, 95%CI 0.704-0.920, p=0.001) and creatinine clearance (OR:0.969, 95%CI 0.956-0.981, p0.001). Conclusion Unlike series described in literature and despite differences in clinical and echocardiographic characteristics, multivalve surgery had similar outcomes to single-valve surgery. These findings may be attributed to technical improvements and technological advancements in valve intervention, leading to better results even in more complex patients.