HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Piroze M. Davierwala Michael A. Borger Tirone E. David Vivek Rao Terrence M. Yau Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Davierwala, P. M. Articles by Yau, T. M. Search for Related Content PubMed PubMed Citation Articles by Davierwala, P. M. Articles by Yau, T. M. Related Collections Valve disease

J Thorac Cardiovasc Surg 2006;131:329-335
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reoperation is not an independent predictor of mortality during aortic valve surgery

Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Received for publication March 10, 2005; revisions received August 14, 2005; accepted for publication September 9, 2005.

^_* Address for reprints: Terrence M. Yau, MD, MSc, FRCSC, Toronto General Hospital, 4N-470, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. (Email: terry.yau{at}utoronto.ca).

OBJECTIVE: Reoperations on aortic valves are associated with increased mortality, which may affect valve prosthesis selection at the time of initial aortic valve replacement. We analyzed our experience to determine whether reoperation itself independently predicts mortality during aortic valve surgery.

METHODS: Demographic, intraoperative, and outcome data were collected prospectively on patients undergoing primary or redo aortic valve replacement or Bentall procedures after previous aortic valve replacement with or without concomitant coronary bypass grafting at a single institution from 1990 through 2002. Logistic regression analyses validated by means of bootstrap methodology identified the predictors of hospital mortality and the independent effect of reoperation.

RESULTS: Of 2673 patients undergoing aortic valve surgery, 2375 were primary operations, 216 were reoperations, and 82 were Bentall–after–aortic valve replacement procedures. Of 298 reoperations, 32 were third and 5 were fourth procedures. Mortality was 2.3% for primary operations, 4.6% for redo aortic valve replacement, and 2.4% for Bentall–after–aortic valve replacement procedures. Most patients underwent elective procedures, with mortalities of 1.6%, 1.7%, and 2.5%, respectively. Hospital mortality was independently predicted by peripheral vascular disease (odds ratio, 3.6), active endocarditis (odds ratio, 2.9), worsening New York Heart Association class (odds ratio, 2.3), and need for annular enlargement (odds ratio, 2.1). Reoperation itself did not predict hospital mortality.

CONCLUSIONS: The risk of mortality during aortic valve surgery is due mostly to active endocarditis, New York Heart Association class, and comorbidity. We failed to find a significant effect of reoperation on perioperative mortality. Mechanical valves, with their attendant anticoagulation-related morbidity, should not be implanted solely because of anticipated high mortality associated with bioprosthetic rereplacement.

This article has been cited by other articles:

				P. Totaro, S. Carlini, M. Pozzi, F. Pagani, G. Zattera, A. M. D'Armini, and M. Vigano Minimally invasive approach for complex cardiac surgery procedures. Ann. Thorac. Surg., August 1, 2009; 88(2): 462 - 466. [Abstract] [Full Text] [PDF]

				N. U. Khan and N. Yonan Does preoperative computed tomography reduce the risks associated with re-do cardiac surgery? Interactive CardioVascular and Thoracic Surgery, July 1, 2009; 9(1): 119 - 123. [Abstract] [Full Text] [PDF]

				N. Khaladj, M. Shrestha, S. Peterss, I. Kutschka, M. Strueber, L. Hoy, A. Haverich, and C. Hagl Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete? Eur. J. Cardiothorac. Surg., February 1, 2009; 35(2): 260 - 264. [Abstract] [Full Text] [PDF]

				A. Ali, Y. Abu-Omar, A. Patel, A. Y. Sheikh, Z. Ali, A. Saeed, A. Akhtar, T. Athanasiou, and J. Pepper Propensity analysis of survival after subcoronary or root replacement techniques for homograft aortic valve replacement. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 334 - 341. [Abstract] [Full Text] [PDF]

				T. M. Joudinaud, F. Baron, R. Raffoul, B. Pagis, M. Vergnat, C. Parisot, U. Hvass, and P. R. Nataf Redo aortic root surgery for failure of an aortic homograft is a major technical challenge Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 989 - 994. [Abstract] [Full Text] [PDF]

				M. A. Borger, K. Prasongsukarn, S. Armstrong, C. M. Feindel, and T. E. David Stentless Aortic Valve Reoperations: A Surgical Challenge Ann. Thorac. Surg., September 1, 2007; 84(3): 737 - 744. [Abstract] [Full Text] [PDF]