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J Thorac Cardiovasc Surg 2001;122:913-918
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Departments of Cardiac Surgerya and Epidemiology and Public Healthb (Queen's University), Royal Victoria Hospital, Belfast, Northern Ireland.
Received for publication Nov 13, 2000. Revisions requested Feb 8, 2001; revisions received March 20, 2001. Accepted for publication March 28, 2001. Address for reprints: Mr H. O'Kane, Department of Cardiac Surgery, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland (E-mail: jmj12{at}hotmail.com).
Abstract
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 
2 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.
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