Document Detail


Short-term results of repeat valve replacement: a predictive factor analysis.
MedLine Citation:
PMID:  20583395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: The new-generation bioprostheses are associated with a longer lifespan, and therefore tend to be implanted in younger patients. However, with the increase in life expectancy, the trend is towards a higher rate of repeat valve replacement. Hence, the study aim was to evaluate the present mortality and risk factors for repeat valvular surgery. METHODS: A total of 183 consecutive patients (87 males, 96 females; mean age 62 years; range: 28-88 years) who underwent repeat valve replacement at the authors' institution between 2001 and 2004 was reviewed. Reoperations in these patients were required due to structural degeneration of the bioprosthesis (50%), to paravalvular leak (20%), and to prosthetic endocarditis (14%), valve thrombosis (9%), and plasty failure (9%). In total, 105 patients (57%) had received at least one bioprosthesis during the previous operation, 58 (31%) had a mechanical valve, 15 (8%) had an isolated mitral plasty, and five (2%) hybrid procedures. All preoperative and operative risk factors were studied. RESULTS: The overall operative mortality rate was 6.6% (n = 12), but only 3.9% (n = 4) for the bioprosthesis reoperation. The risk factors for mortality included pulmonary hypertension (> 60 mmHg; p = 0.03), renal insufficiency (p = 0.02), more than one repeat valve replacement (p = 0.004), previous mechanical prosthesis (p = 0.02), previous mitral surgery (p = 0.019), and associated tricuspid surgery (p = 0.03). CONCLUSION: The data acquired tended to show that repeat valve replacement of bioprostheses may be carried out with an acceptable operative risk, in connection with the majority of operations on bioprostheses being secondary to structural degeneration of the implant. Hence, in most cases a well-controlled, programmed operation would lead to very low mortality (< 4%), despite a significant morbidity rate.
Authors:
Sylvain Beurtheret; Vlad Gariboldi; Horea Feier; Dominique Grisoli; Alberto Riberi; Annick Mouly-Bandini; Dominique Métras; Francois Kerbaul; Frédéric Collart
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  19     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-29     Completed Date:  2010-07-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  326-32     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, Timone University Hospital, Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bioprosthesis*
Factor Analysis, Statistical
Female
Heart Valve Diseases / mortality,  surgery
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Hospital Mortality
Humans
Male
Middle Aged
Postoperative Complications / epidemiology
Reoperation
Retrospective Studies
Risk Factors
Treatment Outcome

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


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