JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Benjamin B. Peeler
John A. Kern
Irving L. Kron
Gorav Ailawadi
Right arrow Permission Requests
Google Scholar
Right arrow Articles by LaPar, D. J.
Right arrow Articles by Ailawadi, G.
PubMed
Right arrow Articles by LaPar, D. J.
Right arrow Articles by Ailawadi, G.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2010;139:263-272
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Outcomes of reoperative aortic valve replacement after previous sternotomy

Damien J. LaPar, MD, Zequan Yang, MD, George J. Stukenborg, PhD, Benjamin B. Peeler, MD, John A. Kern, MD, Irving L. Kron, MD, Gorav Ailawadi, MD*

Department of Surgery, University of Virginia, Charlottesville, Va

Received for publication April 30, 2009; revisions received July 17, 2009; accepted for publication September 4, 2009.

* Address for reprints: Gorav Ailawadi, MD, PO Box 800679, Charlottesville, VA 22908-0679. (Email: gorav{at}virginia.edu).

Objective: Increasingly, patients with previous sternotomy require aortic valve replacement. We compared outcomes of reoperative aortic valve replacement after previous sternotomy and primary aortic valve replacement by surgical era. Effect of initial cardiac operation on reoperative aortic valve replacement was also investigated.

Methods: Between January 1996 and December 2007, a total of 1603 patients undergoing elective aortic valve replacement were entered prospectively into our clinical database. Patients were divided into eras A (1996–1999), B (2000–2003), and C (2004–2007). A total of 191 patients (12%) had previous sternotomy for coronary artery bypass grafting (n = 88), coronary artery bypass grafting with aortic valve replacement (n = 16), aortic valve replacement with or without other aortic procedure (n = 70), and other cardiac procedures (n = 17). Mean ages were 66.5 ± 13.1 years in reoperative group and 65.5 ± 14.9 years in primary group.

Results: Mortality in reoperative group decreased significantly with time (A 15.4% vs B 15.1% vs C 2.0%, P = .004) and was equivalent to primary group in era C (3.5% vs 2.0%, P = .65). Major complications also significantly decreased with time in reoperative group (A 25.6% vs B 17.0% vs C 6.1%, P = .006). Importantly, patients had more comorbidities with time and increased preoperative risk in era C. There were no differences in outcome by initial cardiac operation in reoperative group.

Conclusions: Reoperative aortic valve replacement now carries similar morbidity and mortality to primary replacement. Risk of reoperation is not affected by primary operation.

Abbreviations and Acronyms AVR = aortic valve replacement; CABG = coronary artery bypass grafting; STS = Society of Thoracic Surgeons






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2010 by The American Association for Thoracic Surgery.