title: Multiple valve replacement increases the risk of reoperation for structural degeneration of bioprostheses.
abstract: OBJECTIVE
  The study aim was to analyze the results of reoperations for structural degeneration of bioprostheses, and to define a high-risk population for reoperative procedures.
  
  
  METHODS
  A series of 524 consecutive patients who had undergone a first reoperative replacement for a failed bioprosthesis between 1978 and 1998 was reviewed retrospectively. The reoperative procedure comprised 363 single valve replacements, and 161 multiple valve replacements. During the original procedure, 648 bioprostheses had been implanted in the mitral (n = 403), aortic (n = 220) and tricuspid (n = 25) positions.
  
  
  RESULTS
  The mean interval between the original procedure and reoperation was 8.8 +/- 3.3 years. Tissue valve failure was revealed by recurrence of cardiac insufficiency in 70% of cases. The overall early mortality rate was 8%, but early mortality rates for elective single mitral and aortic reoperative valve replacements were only 3.9% and 4%, respectively. Early mortality following reoperation for single and multiple valve replacement was 6.0% and 12.4% respectively (p = 0.02). Other significant multivariable predictors for early mortality were old age (p = 0.003), NYHA functional class (p = 0.007), presence of ascites (p = 0.02) and reoperation performed before 1988 (p = 0.013).
  
  
  CONCLUSIONS
  The risk of reoperation for structural degeneration of bioprostheses is acceptable for elective single reoperative valve replacement as opposed to multiple reoperative valve replacement. This may limit the use of bioprostheses during the original procedure when multiple valve replacement is required.
authors.affiliation: Service de Chirurgie Cardiaque, CHU Timone Adultes, Marseilles, France.
authors.forename: T
authors.initials: T
authors.lastname: Caus
authors.forename: J N
authors.initials: JN
authors.lastname: Albertini
authors.forename: Y
authors.initials: Y
authors.lastname: Chi
authors.forename: F
authors.initials: F
authors.lastname: Collart
authors.forename: J R
authors.initials: JR
authors.lastname: Monties
authors.forename: T
authors.initials: T
authors.lastname: Mesana
mesh_terms: D001705:Bioprosthesis / Q000706:statistics & numerical data*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome