title: Aortic valve replacement in patients with previous cardiac surgery.
abstract: BACKGROUND
  Whether minimally diseased aortic valves should be replaced during other necessary cardiac operations remains controversial. Part of the decision-making process in that issue revolves around the risks of subsequent aortic valve replacement. This study evaluated the results of aortic valve replacement in patients following prior cardiac surgery.
  
  
  METHODS
  From February, 1984 through December, 2001 first-time aortic valve replacement was performed in 132 consecutive patients who had previous cardiac surgery utilizing cardiopulmonary bypass. Of those patients 89 (67%) had aortic valve replacement at a mean of 8.3 years after prior coronary artery bypass grafting, and 43 (33%) had aortic valve replacement at a mean of 13.0 years after previous procedures other than myocardial revascularization. Hospital records of all patients were retrospectively reviewed.
  
  
  RESULTS
  Early complications included operative mortality in six (6.7%) of the patients with prior coronary grafting and no mortality in the group with other prior operations. Patients having prior coronary grafting had more nonfatal complications than those with other previous procedures.
  
  
  CONCLUSIONS
  Aortic valve replacement in patients following previous cardiac surgery can be accomplished with acceptable mortality and morbidity. Routine replacement of aortic valves that are minimally diseased during coronary artery bypass grafting may not be warranted.
authors.affiliation: Cardiac Surgical Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. cakins@partners.org
authors.forename: Cary W
authors.initials: CW
authors.lastname: Akins
authors.forename: Alan D
authors.initials: AD
authors.lastname: Hilgenberg
authors.forename: Gus J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: Joren C
authors.initials: JC
authors.lastname: Madsen
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome