Abstract
A retrospective study was conducted on 124 patients who underwent re-replacement of previously implanted prosthetic heart valves for structural valve failure, prosthetic valve endocarditis, periprosthetic leak, a thrombosed valve, hemolysis, or prophylactic removal. In total, 85% of the explanted valves were bioprostheses, and 70% of the newly implanted valves were mechanical valves. The overall operative mortality rate was 8.1%, being 3.2% of 95 single valve recipients and 25.0% of 28 double valve recipients (P < 0.001). The overall mortality rate dropped from 13.6% of 66 patients before 1988, to 1.7 % of 58 patients encountered in the last 3 years (P < 0.02). Since 1988, a third of the patients have undergone reoperation without homologous blood transfusion. A univariate analysis revealed eight operative risk factors, namely: higher values of preoperative blood urea nitrogen or total bilirubin, double valve replacement at the redo operation, NYHA class IV, urgency of reoperation, a duration of implantation of less than 3 months, reoperation in the earlier period of this study, and reexploration for bleeding or cardiac tamponade after re-replacement surgery. A multivariate statistcial analysis demonstrated that preoperative blood urea nitrogen, urgency of reoperation, double valve replacement, and the duration of implantation were independent risk factors. Thus, we recommend that surgery be performed early, before the occurrence of other organ failure induced by congestive heart failure due to any form of valve dysfunction.
Similar content being viewed by others
References
Edmunds LH Jr, Clark RE, Cohn LH, Miller C, Weisel RD (1988) Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg 46:257–259
Kawachi Y, Tanaka J, Tominaga R, Kinoshita K, Tokunaga K (1992) More than ten years' follow-up of the Hancock porcine bioprosthesis in Japan. J Thorac Cardiovasc Surg 104:5–13
Nakamura Y, Masuda M, Toshima Y, Asou T, Oe M, Kinoshita K, Kawachi Y, Tanaka J, Tokunaga K (1990) Comparative study of Cell Saver and ultrafiltration. Nontransfusion in cardiac surgery. Ann Thorac Surg 49:973–978
Kinoshita K, Oe M, Tokunaga K (1991) Superior protecive effect of low-calcium, magnesium-free potassium cardioplegic solution on ischemic myocardium. Clinical study in comparison with St. Thomas' Hospital solution. J Thorac Cardiovasc Surg 101:695–702
Harrell FE (1986) “The LOGIST procedure”, SUGI supplement library guide, 5th edn. SAS Institute, Cary, NC
Dobell ARC, Jain AK (1984) Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg 37:273–278
Husebye DG, Pluth JR, Pichler JM, Schaff HV, Orszulak TA, Puga FJ, Danielson GK (1983) Reoperation on prosthetic heart valves. An analysis of risk factors in 552 patients. J Thorac Cardiovasc Surg 86:543–552
Bosch X, Pomar JL, Pelletier LC (1984) Early and late prognosis after reoperation for prosthetic valve replacement. J Thorac Cardiovasc Surg 88:567–572
Lytle BW, Cosgrove DM, Taylor PC, Gill CC, Goormastic M, Golding LIZ, Stewart RW, Loop FD (1986) Reoperations for valve surgery: Perioperative mortality and determinants of risk for 1,000 patients, 1958–1984. Ann Thorac Surg 42:632–643
Bortolotti U, Mazzucco A, Milano A, Gallucci V (1988) Technical considerations in reoperation for porcine bioprosthetic valve failure. J Cardiac Surg 3:459–466
Pansini S, Ottino G, Forsennati PG, Serpieri G, Zattera G, Casabona R, di Summa M, Villani M, Poletti GA, Morea M (1990) Reoperations on heart valve prostheses: An analysis of operative risks and late results. Ann Thorac Surg 50:590–596
Masri Z, Girardet R, Attum A, Barbie R, Yared I, Lansing A (1990) Reoperation for prosthetic heart valve dysfunction. 19 years' experience. Texas Heart Inst J 17:106–111
Deviri E, Sareli P. Wisenbaugh T, Cronje SL (1991) Obstruction of mechanical heart valve prostheses: Clinical aspects and surgical management. J Am Coll Cardiol 17:646–650
Haydock D, Barratt-Boyes B, Macedo T, Kirklin JW, Blackstone E (1992) Aortic valve replacement for active infectious endocarditis in 108 patients. A comparison of freehand allograft valves with mechanical prostheses and bioprostheses. J Thorac Cardiovasc Surg 103:130–139
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kawachi, Y., Matuzaki, K., Tominaga, R. et al. The risks of reoperation for prosthetic valve dysfunction. Surg Today 24, 415–419 (1994). https://doi.org/10.1007/BF01427034
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01427034