Methods: 399 patients (mean age 59.6 years; 205 men and 194 women) who underwent surgery for combined aortic and mitral valve disease between 1986 and 2001 were followed-up. According to the presence of previous aortic and/or mitral valve replacement the patients were divided into two groups, group A (n=281) patients with new aortic and mitral valve disease and group B (n=118) patients with previous aortic and/or mitral valve surgery. The groups were compared regarding mortality, long-term survival, freedom from reoperation, and postoperative morbidity, and long-term functional status. Follow-up was completed for 94% of patients

Results: The perioperative mortality rate was 14.6% for group A and 9.3% for group B (p>0.2). The mean follow-up was significantly longer for group B (5.8±4.0 vs. 7.6±4.4 years, p<0.001). 119 patients died during follow-up (group A n=70; group B n=49; p>0.2), the majority of deaths were cardiac related (group A 61%, group B 69%, p>0.2). Thus the 1, 5, 10 and 15 -year survival for group A was 93±2%, 76±3%, 57±5% and 42±7% and for group B 95±2 %, 75±5%, 50±6% and 40±6% respectively (p>0.2). Freedom from re-operation (97% vs. 100%; p>0.2) and valve related morbidity (69% vs. 59%; p>0.2) was comparable between groups. A significant postoperative improvement in New York Heart Association functional class (NYHA) and functional status (Karnofsky Index) was observed in both groups. However, the improvement was significantly higher in group B patients (NYHA: p<0.001; Karnofsky Index: p<0.001).