|Risk of reoperative valve replacement for failed mitral and aortic bioprostheses.|
|PMID: 9647056 Owner: NLM Status: MEDLINE|
|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.|
|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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|Type: Journal Article; Research Support, Non-U.S. Gov't|
|Title: The Annals of thoracic surgery Volume: 65 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 1998 Jun|
|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|
|Languages: eng Pagination: 1545-51; discussion 1551-2 Citation Subset: AIM; IM|
|Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Aortic Valve / surgery*
Cause of Death
Coronary Artery Bypass
Endocarditis, Bacterial / surgery
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation*
Hypertension, Pulmonary / complications
Kidney Failure / complications
Length of Stay
Mitral Valve / surgery*
Surgical Procedures, Elective
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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