Cardiac valve reoperations: analysis of operative risk factors in 154 patients.
OBJECTIVE
The study aim was to evaluate the operative risks of reoperation on heart valve prostheses.


METHODS
Between January 1985 and December 2000, 154 patients (79 males, 75 females, mean age 61.2+/-9.5 years) underwent cardiac valve reoperation for which indications were prosthetic failure (n = 133; prosthetic mitro-aortic dysfunction occurred in 16 cases), native valve disease in patients with a previous prosthetic valve implantation (n = 12), and both situations concomitantly (n = 9). Total valve replacements numbered 161 (64 in the aortic position, 96 in the mitral position, and one in the tricuspid position). There were 18 valve repairs (eight in the mitral position, 10 in the aortic position). One patient underwent prosthesis thrombectomy (mechanical valve).


RESULTS
Overall operative mortality was 8.4% (n = 13); emergency operation (p <0.002), advanced NYHA class (p <0.026), indication for reoperation (p <0.026), gender (p <0.016) and number of previous reoperations (p = 0.05) were independent determinants for reoperation. Non-significant determinants were age and position of replacement.


CONCLUSIONS
Correct planning of reoperation timing reduces operative risks due to NYHA class (3.8% mortality rate for class II-III versus 21.7% for class IV), and to urgent-emergency procedures (35.7% mortality versus 6.5% for elective operations). The high operative risk of prosthesis thrombosis is a deterrent to implanting mechanical prostheses in patients with disorders of hemostasis.
Beghi
Cesare
C
Department of Cardiac Surgery, University of Parma, Italy.
De Cicco
Giuseppe
G
Nicolini
Francesco
F
Ballore
Luca
L
Reverberi
Claudio
C
Gherli
Tiziano
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery