Operative mortality after valvular reoperations.
BACKGROUND
To determine the incidence and risk factors of mortality and morbidity in valvular reoperations.


METHODS
Between January 1993 and December 2003, 309 valvular reoperations were performed. The reasons for reoperations were reconstructive surgery in first operation (110 patients, 35.5%), prosthetic valve endocarditis (12 patients, 3.8%), periprosthetic leakage (32 patients, 10.3%), new valve degenerations (12 patients, 3.8%), bioprosthetic dysfunction (92 patients, 29.7%), acute thrombotic stuck valve (30 patients, 9.7%), and pannus formation (21 patients, 6.7%). Mitral valves were replaced in 235 patients, aortic valves were replaced in 32 patients, 24 patients had aortic and mitral valve replacements, 2 patients had mitral and tricuspid valve replacements, and reconstruction of periprosthetic leakage was held in 16 patients. 264 patients had elective surgery, whereas 45 were operated on emergency basis.


RESULTS
Hospital mortality was 14.23%. Mortality rate was found to be 10.6% for elective cases and 35.5% for emergency cases. Permanent pacemaker was required in 12 patients, 3 patients had cerebrovascular events, and mediastinitis was observed in 1 patient. Multivariate analysis demonstrated that age > 60 (P = .006; OR 7.3, 95% CI 1.7-30.1), emergency surgery (P = .001; OR 8.1, 95% CI 2.4-27.7), preoperative cerebrovascular accident (P = .003; OR 11.8, 95% CI 2.458.7), and concomitant ascending aorta replacement (P < .001; OR 27.4, 95% CI 6-127) were independent risk factors.


CONCLUSIONS
Valvular reoperations can be carried out with acceptable morbidity and mortality in elective operations but mortality rates are still very high in emergent cases.
Toker
Mehmet Erdem
ME
Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. mertoker@yahoo.com
Kirali
Kaan
K
Balkanay
Mehmet
M
Eren
Ercan
E
Ozen
Yücel
Y
Güler
Mustafa
M
Yakut
Cevat
C
D000328:Adult; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D009017:Morbidity; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors