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European Journal of Cardio-Thoracic Surgery, Vol 7, 34-37, Copyright © 1993 by European Association for Cardio-thoracic Surgery
U Niederhauser, T Carrel, LK von Segesser, A Laske and M Turina
Between 1968 and 1990, 68 patients (33 male, 35 female) with a mean age of
47 years were subjected to reoperation (62 valve replacements, 6
reconstructions) after primary mitral valve reconstruction (mean interval =
81 months). The indication for reoperation was residual valve insufficiency
in 51, and stenosis in 17 patients. The average preoperative New York Heart
Association (NYHA) class was 3.0. The average follow-up was 63 months. The
operative mortality was 8.8% (8 out of 68 patients). The actuarial late
survival was 90% after 5, and 73% after 8 years. After a second mitral
valve reconstruction 66% (four out of six patients) died (one early, three
late). The incidence of second reoperations was 4.4% (3 out of 68
patients), and of thromboembolic complications 11.8% (8 out of 68
patients). The mean NHYHA class improved significantly. The actuarial
freedom from second reoperations was 98% and 90%, and from thromboembolic
complications 91% and 82% after 5 and 10 years, respectively. Endocarditis
did not occur, whereas two patients on Coumadin anticoagulation had
non-fatal gastrointestinal bleeding. Late survival was less favorable (P
< 0.05) in patients operated on before 1980, in a higher preoperative
NYHA class, after a second valve reconstruction, and if pulmonary
hypertension or atrial fibrillation was present. Significant independent
risk factors were older age and earlier reoperation, pulmonary hypertension
or higher NYHA class postoperatively. For the last to years it has been
possible to perform reoperations after mitral valve reconstructions with
good early and excellent late results. The mortality and complication rates
were similar to those for primary mitral valve reconstructions.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Reoperation after mitral valve reconstruction: early and late results
Klinik fur Herzgefasschirurgie, Universitatsspital, Zurich, Switzerland.
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