Indications for reoperation for valvular prosthesis dysfunction in urgent and elective patients.
OBJECTIVE
Comparison analysis of indications for operation, early clinical outcomes and hospital mortality between patients reoperated for valvular prosthesis dysfunction urgently and electively.


METHODS
Retrospective data analysis of 94 patients (pts) reoperated for valve prosthesis dysfunction at Department of Cardiovascular Surgery and Transplantology in Kraków, Poland between January 1999 and December 2002.


RESULTS
Valvular reoperation was elective procedure in 69 pts (73.4%)--group A: 46 males (M), 23 females (F), age 23-71 (av. 51.31 +/- 10.2). Urgent operation was performed in 25 pts--group B: 17 M, 8 F, age 29-77 years (av. 5.41 +/- 13.26). In group B: 9 patients underwent reoperation for dysfunction of aortic valve (2 allogenic, 7 mechanical), 13 pts for mitral valve dysfunction and 3 pts for both aortic and mitral valve dysfunction. In group A: 24 pts for mitral valve dysfunction, 37 pts for aortic valve dysfunction (25 allogenic, 12 mechanical) and 8 pts for both aortic and mitral valve dysfunction. In group B: 16 pts (64%) were operated in NYHA class IV; 8 in cardiogenic shock; on which 8 pts with active endocarditis, 3 pts with sepsis and 1 patient in septic shock. Average operative risk calculated as Euroscore was 30.86 in group B and 13.15 in group A (p<0.05). Overall hospital mortality was 12.6% (12 pts). In group B: 7 pts died (28%), 3 pts due to multiorgan failure, 1 patient due to sepsis, 2 pts due to aorta rupture and 1 due to left ventricle rupture during cardiopulmonary rescuscitation. In group B 5 pts died (7.2%).


CONCLUSIONS
Patients reoperated urgently for valve prosthesis dysfunction were in worse preoperative state, had significantly higher preoperative risk and in hospital mortality than patients reoperated electively.
Sadowski
Jerzy
J
Klinika Chirurgii Serca, Naczyń i Transplantologii, Instytut Kardiologii, Collegium Medicum Uniwersytet Jagielloński, Krakowski Szpital Specjalistyczny im. Jana Pawła II. kardiochir@szpitaljp2.krakow.pl
Kapelak
Bogusław
B
Wróbel
Krzysztof
K
Piatek
Jacek
J
Rudziński
Paweł
P
Wierzbicki
Karol
K
Marek
Grzegorz
G
Drwiła
Rafał
R
Sobczyk
Dorota
D
Grudzień
Grzegorz
G
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome