title: Risk of reoperation for structural failure of aortic and mitral tissue valves.
abstract: OBJECTIVE
  The study aim was to assess the risk of reoperation for patients with a failing stented tissue valve.
  
  
  METHODS
  Between 1980 and 1999, 259 patients (118 males, 141 females; mean age 60.1+/-15.4 years) underwent redo valve replacement to replace a failing stented tissue valve. Of these patients, 94 (36.3%) underwent redo aortic valve replacement (AVR), 105 (40.5%) redo mitral valve replacement (MVR), and 60 (23.2%) redo aortic and mitral valve replacement (DVR). Twenty patients (7.7%) had previous coronary artery bypass grafting (CABG); further CABG were performed in 32 cases (12.4%). Preoperatively, 216 patients (83.3%) were in NYHA functional class III or IV.
  
  
  RESULTS
  The early mortality was (6.5%; n = 17), including three patients who had AVR, five DVR, and nine MVR. A higher preoperative NHYA status (p <0.0004) and emergency surgery (p <0.0001) were significantly associated with an increased risk of operative death (univariate analysis). Age at surgery (p = 0.45), previous CABG (p = 0.45), position of the valve replaced (p = 0.2), type of implant (p = 0.06) and presence of coronary artery disease (p = 0.51) were not associated with a significant risk of operative mortality. Including those patients who died, 88 (34.0%) experienced a peri- or postoperative complication, seven of which (2.7%) were permanent.
  
  
  CONCLUSIONS
  A failing tissue valve can be replaced, with acceptable operative mortality and morbidity. The choice of valve is a balance of its advantages and disadvantages, and these must be discussed with the patient. It appears, however, that the trend towards reducing the age at which tissue valve implantation is performed may be justified.
authors.affiliation: Southampton General Hospital, UK.
authors.forename: Malcolm J R
authors.initials: MJ
authors.lastname: Dalrymple-Hay
authors.forename: Timothy
authors.initials: T
authors.lastname: Crook
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Haw
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bayfield
authors.forename: Nick P
authors.initials: NP
authors.lastname: Hendel
authors.forename: Steven A
authors.initials: SA
authors.lastname: Livesey
authors.forename: Clifford F
authors.initials: CF
authors.lastname: Hughes
authors.forename: James L
authors.initials: JL
authors.lastname: Monro
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D009017:Morbidity; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology