Repeat heart valve surgery: Risk factors for operative mortality

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 122; no. 5; pp. 913 - 918
• Main Authors: Jones, J.Mark, O'Kane, Hugh, Gladstone, Dennis J., Sarsam, Mazin A.I., Campalani, Gianfranco, MacGowan, Simon W., Cleland, Jack, Cran, Gordon W.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.11.2001; AATS/WTSA; Elsevier
• Subjects: Aortic Valve; Biological and medical sciences; Female; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - mortality; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Mitral Valve; Prosthesis Failure; Reoperation; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tricuspid Valve; Human; Reoperation; Prognosis; Surgery; Mortality; Risk factor; Exploration; Heart valve
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2001.116470

Background: Patients undergoing repeat heart valve operations are a diverse population. We assessed risk factors for operative mortality in patients undergoing a first heart valve reoperation. Methods: A retrospective review of hospital records was performed for 671 patients who underwent first repeat heart valve operations between 1969 and 1998. Univariable and multivariable analyses were performed. Results: Operative mortality was 8.6%. Mortality fell each decade to 4.8% in the most recent period (adjusted χ2 for linear trend P ||.0005). Mortality increased from 3.0% for reoperation for a failed repair or reoperation at a new valve site to 10.6% for prosthetic valve dysfunction or periprosthetic leak and to 29.4% for endocarditis or valve thrombosis. Concomitant coronary artery bypass grafting was associated with a mortality of 15.4% compared with 8.2% when it was not required. Mortality for aortic valve replacement was 6.4%, mitral valve replacement 7.4%, aortic and mitral valve replacement 11.5%, tricuspid valve replacement 25.6%, periprosthetic leak repair 9.1%, and isolated valve repair 2.2%. Among 336 patients requiring replacement of prosthetic valves, mortality was 26.1% for replacement of a mechanical valve compared with 8.6% for replacement of a tissue valve (P ||.0005). Multivariable analyses identified year of reoperation, age, coronary artery bypass grafting, indication, and replacement of a mechanical valve rather than a tissue valve as significant explanatory variables for operative mortality. Conclusions: Heart valve reoperations can be performed with an acceptable operative mortality. However, we have identified several categories of patients in whom reoperation carries an increased risk. J Thorac Cardiovasc Surg 2001;122:913-8