HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul R. Vogt Mario Lachat Marko I. Turina Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vogt, P. R. Articles by Turina, M. I. Search for Related Content PubMed PubMed Citation Articles by Vogt, P. R. Articles by Turina, M. I.

Eur J Cardiothorac Surg 2000;17:134-139
© 2000 Elsevier Science NL

Reoperative surgery for degenerated aortic bioprostheses: predictors for emergency surgery and reoperative mortality

Clinic for Cardiovascular Surgery and Cardiology, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland

Corresponding author. Tel.: +41-1-255-1111; fax: +41-1-255-4446
e-mail: paul.vogt{at}chi.usz.ch

Objective: The long-term outcome of patients with aortic bioprosthetic valves could be improved by decreasing the reoperative mortality rate. Methods: Predictors of emergency reoperation and reoperative mortality were identified retrospectively in 172 patients who had the first bioprosthetic aortic valve replacement between 1975 and 1988 (mean age 46±13 years) and were subjected to replacement of the degenerated bioprostheses between 1978 and 1997 (mean age 56±14 years). Emergency reoperation had to be performed in 31 patients (18%). Results: The operative mortality was 5.2% (9/172), 22.6% for emergency (odds ratio 11.17; 95%-confidence limit 4.33–28.85) and 1.4% for elective replacement of the degenerated aortic bioprosthesis (P<0.0001; OR=20.3). Patients who died at reoperation had higher transvalvular gradients before the primary aortic valve replacement (P=0.007), received smaller bioprostheses at the first operation (P=0.03), had later recurrence of symptoms after the first aortic valve replacement (P=0.04), a higher pre-reoperative New York Heart Association (NYHA) class (P=0.02), and a higher incidence of coronary artery disease (P=0.001) and pulmonary artery hypertension (P=0.009). Endocarditis before the primary aortic valve replacement (P=0.004), postoperative pneumonia at the first operation (P=0.005), pulmonary hypertension (P=0.0004) acquired during the interval, later recurrence of symptoms (P=0.04) after the first operation, a lower ejection fraction at the time of reoperation (P=0.03) and acute onset of bioprosthetic regurgitation (P=0.00002) were predictors for emergency surgery. Higher transvalvular gradients at the primary aortic valve replacement (P=0.006), coronary artery disease (P=0.003) acquired during the interval, the need for concomitant coronary artery revascularization (P=0.001), sex (P=0.02) and size (P=0.05) and type of the bioprostheses used (P=0.007) were incremental predictors for reoperative mortality which were independent of emergency surgery. Conclusions: Elective replacement of failed aortic bioprostheses is safe. Patients undergoing emergency reoperation have a considerably higher mortality. They can be identified by a history of native aortic valve endocarditis, higher transvalvular gradients at primary aortic valve replacement, smaller bioprostheses, and pulmonary hypertension or coronary artery disease acquired during the interval. A failing bioprosthesis must be replaced at its first sign of dysfunction.

Key Words: Degenerated aortic bioprosthesis • Reoperation • Predictors • Mortality

This article has been cited by other articles:

				A. Carozza, A. Della Corte, F. Ursomando, and M. Cotrufo The Choice of Valve Prosthesis for Infective Endocarditis in Intravenous Drug Users: Between Evidence and Preference Ann. Thorac. Surg., March 1, 2008; 85(3): 1141 - 1141. [Full Text] [PDF]

				J. P. Greelish, R. M. Ahmad, J. M. Balaguer, M. R. Petracek, and J. G. Byrne Reoperative Valve Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 1159 - 1174. [Full Text]

				G. H.L. Tang, M. Maganti, T. E. David, C. M. Feindel, H. E. Scully, and M. A. Borger Effect of Prior Valve Type on Mortality in Reoperative Valve Surgery Ann. Thorac. Surg., March 1, 2007; 83(3): 938 - 945. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]

				P. M. Davierwala, M. A. Borger, T. E. David, V. Rao, M. Maganti, and T. M. Yau Reoperation is not an independent predictor of mortality during aortic valve surgery J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 329 - 335. [Abstract] [Full Text] [PDF]

				D. D. Potter, T. M. Sundt III, K. J. Zehr, J. A. Dearani, R. C. Daly, C. J. Mullany, C. G.A. McGregor, F. J. Puga, H. V. Schaff, and T. A. Orszulak Operative risk of reoperative aortic valve replacement J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 94 - 103. [Abstract] [Full Text] [PDF]

				W.R.E. Jamieson, L.H. Burr, R.T. Miyagishima, M.T. Janusz, G.J. Fradet, H. Ling, and S.V. Lichtenstein Re-operation for bioprosthetic aortic structural failure - risk assessment Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 873 - 878. [Abstract] [Full Text] [PDF]

				W.R.E. Jamieson, L.H. Burr, R.T. Miyagishima, M.T. Janusz, G.J. Fradet, S.V. Lichtenstein, and H. Ling Reoperation for Bioprosthetic Mitral Structural Failure: Risk Assessment Circulation, September 9, 2003; 108(90101): II-98 - 102. [Abstract] [Full Text] [PDF]

				J. G. Byrne, B. J. Phillips, and L. H. Cohn Reoperative Valve Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 1047 - 1056. [Full Text]

				A. S. Geha, M. G. Massad, and N. J. Snow Replacement of degenerated mitral and aortic bioprostheses without explantation Ann. Thorac. Surg., November 1, 2001; 72(5): 1509 - 1514. [Abstract] [Full Text] [PDF]

				C. Alexiou, Q. Chen, S. M. Langley, A. P. Salmon, B. R. Keeton, M. P. Haw, and J. L. Monro Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 239 - 246. [Abstract] [Full Text] [PDF]

				C. Alexiou, S. M. Langley, M. J.R. Dalrymple-Hay, A. P. Salmon, B. R. Keeton, M. P. Haw, and J. L. Monro Open commissurotomy for critical isolated aortic stenosis in neonates Ann. Thorac. Surg., February 1, 2001; 71(2): 489 - 493. [Abstract] [Full Text] [PDF]