title: Risk of reoperative valve replacement for failed mitral and aortic bioprostheses.
abstract: BACKGROUND
  One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure.
  
  
  METHODS
  Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed.
  
  
  RESULTS
  Reoperations were for failed bioprosthetic mitral valves in 219 patients, failed aortic valves in 153 patients, and failed aortic and mitral valves in 28 patients. Including 26 operations (6%) for acute endocarditis, 153 operations (38%) were nonelective. One hundred nine patients (27%) had other valves repaired or replaced, and 72 (18%) had coronary bypass grafting. The incidence of death in the mitral, aortic, and double-valve groups was respectively, 15 (6.8%), 12 (7.8%), and 4 (14.3%); and the incidence of prolonged postoperative hospital stay (>14 days) was, respectively, 57 (26.0%), 41 (26.8%), and 8 (28.6%). Only 7 of 147 patients (4.8%) having elective, isolated, first-time valve reoperation died. Multivariable predictors (p < 0.05) of hospital death were age greater than 65 years, male sex, renal insufficiency, and nonelective operation; and predictors of prolonged stay were acute endocarditis, renal insufficiency, any concurrent cardiac operation, and elevated pulmonary artery systolic pressure.
  
  
  CONCLUSIONS
  Reoperative bioprosthetic valve replacement can be performed with acceptable mortality and hospital stay. The best results are achieved with elective valve replacement, without concurrent cardiac procedures.
authors.affiliation: Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Akins
authors.forename: M J
authors.initials: MJ
authors.lastname: Buckley
authors.forename: W M
authors.initials: WM
authors.lastname: Daggett
authors.forename: A D
authors.initials: AD
authors.lastname: Hilgenberg
authors.forename: G J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: D F
authors.initials: DF
authors.lastname: Torchiana
authors.forename: J C
authors.initials: JC
authors.lastname: Madsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002423:Cause of Death; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D004697:Endocarditis, Bacterial / Q000601:surgery; D005260:Female; D005544:Forecasting; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D011475:Prosthesis Failure; D051437:Renal Insufficiency / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors