Document Detail

Third-time aortic valve replacement: patient characteristics and operative outcome.
MedLine Citation:
PMID:  20103324     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Reoperative cardiac surgery is being performed with increasing frequency. Third-time aortic valve surgery remains a rare procedure. We retrospectively analyzed the outcome of third-time aortic valve replacement (AVR) at our institution. METHODS: Between 1990 and 2005, 49 patients underwent third-time AVR. Data analyzed included preoperative patient characteristics, type of preexisting aortic valve prosthesis, prosthetic valve pathology necessitating third-time AVR, postoperative morbidity and mortality, and echocardiographic data. RESULTS: The mean age was 47.4 +/- 17 years. The mean interval between the first and second operation was 8.7 +/- 5.7 years, and between the second and third operation it was 10.2 +/- 5.6 years. Prosthetic valves at the time of second AVR included 32 homografts (65.4%), 11 mechanical prostheses (22.4%), and 6 xenografts (12.2%). At third-time AVR, 29 patients (59.2%) received a homograft or autograft, 12 (24.5%) received a mechanical valve, and 8 (16.3%) received a xenograft. In-hospital mortality was 4.1%. The mean follow-up was 80 +/- 69 months. Freedom from reoperation was 84% +/- 6% at 5 years and 65% +/- 11% at 10 years. Long-term survival was 79% +/- 6% at 5 years and 73% +/- 7% at 10 years. Multivariate analysis showed that age, female sex, and postoperative high left ventricular mass were factors associated with decreased long-term survival. Mean left ventricular mass decreased from 320 +/- 133 g to 263 +/- 102 g at 1 year postoperatively (p = 0.01). CONCLUSIONS: Third-time AVR can be performed with low operative mortality, low cumulative operative mortality, and satisfactory long-term survival and freedom from reoperation. The procedure results in significant regression of left ventricular mass.
Kasra Shaikhrezai; Giordano Tasca; Mohamed Amrani; Gilles Dreyfus; George Asimakopoulos
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  479-83     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
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MeSH Terms
Age Factors
Aortic Valve Insufficiency / mortality,  surgery*
Aortic Valve Stenosis / mortality,  surgery*
Cause of Death
Echocardiography, Transesophageal
Heart Valve Prosthesis*
Hospital Mortality
Hypertrophy, Left Ventricular / etiology,  mortality,  surgery
Kaplan-Meiers Estimate
Middle Aged
Postoperative Complications / etiology,  mortality,  surgery*
Prosthesis Design
Prosthesis Failure*
Prosthesis-Related Infections / mortality,  surgery*
Reoperation / mortality
Retrospective Studies
Sex Factors
Survival Analysis
Comment In:
Ann Thorac Surg. 2010 Feb;89(2):484   [PMID:  20103325 ]

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