Document Detail


Risk of reoperative valve replacement for failed mitral and aortic bioprostheses.
MedLine Citation:
PMID:  9647056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure. METHODS: Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed. RESULTS: Reoperations were for failed bioprosthetic mitral valves in 219 patients, failed aortic valves in 153 patients, and failed aortic and mitral valves in 28 patients. Including 26 operations (6%) for acute endocarditis, 153 operations (38%) were nonelective. One hundred nine patients (27%) had other valves repaired or replaced, and 72 (18%) had coronary bypass grafting. The incidence of death in the mitral, aortic, and double-valve groups was respectively, 15 (6.8%), 12 (7.8%), and 4 (14.3%); and the incidence of prolonged postoperative hospital stay (>14 days) was, respectively, 57 (26.0%), 41 (26.8%), and 8 (28.6%). Only 7 of 147 patients (4.8%) having elective, isolated, first-time valve reoperation died. Multivariable predictors (p < 0.05) of hospital death were age greater than 65 years, male sex, renal insufficiency, and nonelective operation; and predictors of prolonged stay were acute endocarditis, renal insufficiency, any concurrent cardiac operation, and elevated pulmonary artery systolic pressure. CONCLUSIONS: Reoperative bioprosthetic valve replacement can be performed with acceptable mortality and hospital stay. The best results are achieved with elective valve replacement, without concurrent cardiac procedures.
Authors:
C W Akins; M J Buckley; W M Daggett; A D Hilgenberg; G J Vlahakes; D F Torchiana; J C Madsen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  65     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-07-16     Completed Date:  1998-07-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1545-51; discussion 1551-2     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Valve / surgery*
Bioprosthesis*
Cause of Death
Coronary Artery Bypass
Endocarditis, Bacterial / surgery
Female
Forecasting
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation*
Hospitalization
Humans
Hypertension, Pulmonary / complications
Incidence
Kidney Failure / complications
Length of Stay
Male
Middle Aged
Mitral Valve / surgery*
Multivariate Analysis
Prosthesis Failure
Reoperation
Retrospective Studies
Risk Factors
Sex Factors
Surgical Procedures, Elective

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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