Document Detail


Outcomes of reoperative aortic valve replacement after previous sternotomy.
MedLine Citation:
PMID:  20006357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Increasingly, patients with previous sternotomy require aortic valve replacement. We compared outcomes of reoperative aortic valve replacement after previous sternotomy and primary aortic valve replacement by surgical era. Effect of initial cardiac operation on reoperative aortic valve replacement was also investigated.
METHODS: Between January 1996 and December 2007, a total of 1603 patients undergoing elective aortic valve replacement were entered prospectively into our clinical database. Patients were divided into eras A (1996-1999), B (2000-2003), and C (2004-2007). A total of 191 patients (12%) had previous sternotomy for coronary artery bypass grafting (n = 88), coronary artery bypass grafting with aortic valve replacement (n = 16), aortic valve replacement with or without other aortic procedure (n = 70), and other cardiac procedures (n = 17). Mean ages were 66.5 +/- 13.1 years in reoperative group and 65.5 +/- 14.9 years in primary group.
RESULTS: Mortality in reoperative group decreased significantly with time (A 15.4% vs B 15.1% vs C 2.0%, P = .004) and was equivalent to primary group in era C (3.5% vs 2.0%, P = .65). Major complications also significantly decreased with time in reoperative group (A 25.6% vs B 17.0% vs C 6.1%, P = .006). Importantly, patients had more comorbidities with time and increased preoperative risk in era C. There were no differences in outcome by initial cardiac operation in reoperative group.
CONCLUSIONS: Reoperative aortic valve replacement now carries similar morbidity and mortality to primary replacement. Risk of reoperation is not affected by primary operation.
Authors:
Damien J LaPar; Zequan Yang; George J Stukenborg; Benjamin B Peeler; John A Kern; Irving L Kron; Gorav Ailawadi
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Publication Detail:
Type:  Journal Article     Date:  2009-12-16
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  139     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-28     Completed Date:  2010-03-02     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  263-72     Citation Subset:  AIM; IM    
Copyright Information:
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, University of Virginia, Charlottesville, VA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bioprosthesis
Comorbidity
Coronary Artery Bypass / statistics & numerical data
Female
Heart Valve Diseases / epidemiology,  surgery*
Heart Valve Prosthesis Implantation / mortality*
Humans
Male
Middle Aged
Reoperation / mortality
Retrospective Studies
Risk Assessment
Risk Factors
Sternum / surgery*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
T32 HL007849/HL/NHLBI NIH HHS; U01 HL088925/HL/NHLBI NIH HHS
Comments/Corrections

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