[Repeated heart valve replacements: prognosis and results].
In order to determine the prognosis of reoperation for valvular replacement, we reviewed the results of a consecutive series of 124 patients operated in the department between 1974 and 1992 (163 multi redo operations). There were 69 women and 55 men, with a mean age 48 years; 77% of the patients were in functional class III or IV. Operations were performed as an emergency in 30% of cases. Endocarditis was found in 24% of cases and was an important risk factor in this content. The main indications for reoperation were periprosthetic leakage in 28.8% of cases and failure of bioprostheses in 23.7%. The valvular replacement was simple in 61%, double in 32% and triple in 7% of cases. An associated procedure was necessary in 27% of cases. Mechanical devices were implanted in 62.3% of cases. Peroperative mortality was 3% and hospital mortality, mainly from cardiac causes, was 21.7% for the second, 20% for the third and 55.6% for the fourth reoperations. Operative mortality was dependent on the number or reoperations, functional class, emergency surgery, duration of bypass and cross-clamping time. Four per cent of patients were lost to follow-up and 30 patients died secondarily. The actuarial survival rate was 52% at 5 years and 33% at 10 years, actuarial survival rate without valvular complication was 41% at 5 years and 19% at 10 years but the functional results remained good with over 90% of patients in functional class I or II at the end of follow-up.
Caus
T
T
Service de chirurgie cardiaque, CHU La Timone-adultes, Marseille.
Mesana
T
T
Mouly
A
A
Guez
P
P
Tapia
M
M
Montiès
J R
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D004696:Endocarditis / Q000209:etiology / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors
Remplacements valvulaires itératifs; pronostic et résultats.