Abstract 4139506: Comparative Analysis of 30-Day Surgical Outcomes: Univalvular vs. Multivalvular Procedures in Contemporary Practice

Introduction: Data on multivalvular surgery are heterogeneous, not contemporary, and are underrepresented from low-income countries where rheumatic disease is prevalent Objectives: To compare clinical, epidemiological data, and surgical outcomes between patients undergoing surgery for one vs. 2 or more concomitant valve diseases. Methods: Patients in the INCORVALV Registry were divided into groups based on the number of valves treated in the same procedure: univalvular vs. multivalvular (2 or more). Outcomes were evaluated at 30 days. Results: Of 459 patients, 400 had single-valve and 59 had multivalve surgery, with only 1 having 3-valve surgery. Groups were similar in age (55±16 vs. 55±15 years, p=0.98), male sex (49.3% vs. 52.5%, p=0.74), NYHA class III or IV (66.7% vs. 76%, p=0.08) and comorbidities such as hypertension (59.6% vs 54.2%, p=0.57) and diabetes (18% vs 22%, p=0.57). Multivalvular patients had higher pulmonary arterial pressure (47.7±19.4 vs. 59.2±19.6 mmHg, p<0.01) and lower creatinine clearance (72.7±33.4 vs. 62.4±25.4 mL/min, p=0.03). In the univalvular group, aortic valve replacement (45.4%) and mitral valve replacement (34.9%) predominated, while in the multivalvular group, aortic valve replacement occurred in 69.5%, mitral valve replacement in 50.8%, mitral valve repair in 42.4%, and tricuspid valve repair in 16.9% of patients. Cardiopulmonary bypass time (101.9±38.1 vs. 139.6±55.3 min, p<0.01) and cross-clamp time (79.3±31.3 vs. 115.2±51.7 min, p<0.01) were higher in the multivalvular group. However, there was no difference in 30-day mortality (12.8% vs. 22.0%, p=0.08), cardiovascular mortality (10.5% vs. 18.6%, p=1.00), stroke (1.3% vs. 3.4%, p=0.23), major bleeding (9.2% vs. 15.5%, p=0.21), surgical site infection (9.2% vs. 8.6%, p=1.00), need for reoperation (8.1% vs. 10.2%, p=0.61) or 30-day hospitalization (5.0% vs 1.7%, p=0.50). Multivalvular surgery was not a predictor of 30-day mortality (HR:1.50, 95% CI 0.611-3.68, p=0.38). Predictors were: diabetes (HR:2.56, 95% CI 1.21-5.43, p=0.01), mitral valve replacement (HR:3.01, 95% CI 1.46-6.19, p<0.01), left ventricular ejection fraction (HR:0.96, 95% CI 0.93-0.99, p<0.01) and creatinine clearance (HR:0.96, 95% CI 0.95-0.98, p<0.01). Conclusion: Multivalvular surgery presents a comparable risk to univalvular surgery, despite older studies. This is likely due to advancements in surgical techniques and a predominance of younger patients, many with rheumatic etiology.