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J Thorac Cardiovasc Surg 1995;109:30-48
© 1995 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Kansas City, Mo., Birmingham, Ala., Rochester, Minn., Portland, Ore., Scottsdale, Ariz., Seattle, Wash., Baltimore, Md., Irvine, Calif.
From the Section of Cardiovascular Surgery, Department of Cardiovascular Diseases, Mid-America Heart Institute of Saint Luke's Hospital, Kansas City, Mo.; the Division of Cardiothoracic Surgery, the Department of Surgery, the University of Alabama at Birmingham Medical Center, Birmingham, Ala.; the Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.; the Center for Outcomes Research and Education for Sisters of Providence Health Care System, Portland, Ore.; the Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Mayo Clinic Scottsdale, Scottsdale, Ariz.; the Department of Epidemiology, University of Washington, Seattle, Wash.; the Department of Biostatistics, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.; and the Shiley Heart Valve Research Center, Irvine, Calif.
Address for reprints: Jeffrey M. Piehler, MD, Medical Plaza II, Suite 50, 4320 Wornall Rd., Kansas City, Mo. 64111.
Abstract
Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new persisting neurologic deficit, and length of postoperative stay, a three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0.3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (90% confidence limits 4 to 13), emphasizing the wide variance in outcome events. Equations were developed to permit wide application of the results of the study for quantitatively estimating the risk of outcome events based on individual preoperative patient characteristics. These estimates should be useful for informed patient consent, considerations of prophylactic valve replacement, and cost and resource use. (J THORAC CARDIOVASC SURG 1995;109:30-48)
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