title: Determinants of hospital mortality after repeat mitral valve surgery for rheumatic mitral valve disease.
abstract: OBJECTIVE
  The aim of this study is to detect the risk factors for hospital mortality in patients who underwent reoperative mitral valve replacement.
  
  
  METHODS
  Rheumatic mitral valve patients who underwent primary mitral valve replacement (386 cases) and repeat mitral valve replacement (94 cases) were analysed retrospectively. The incremental effects of the reoperative procedure on hospital mortality were studied by comparing primary and reoperative procedures and analyzing a series of possible predisposing factors.
  
  
  RESULTS
  Operative mortality for repeat procedures was found significantly higher than the first operations (respectively 12.8% versus 4.3%, p=0.022). Risc factors affecting the hospital mortality in reoperation group were determined as advanced age, diameter of left atrium, prolonged bypass time and development of postoperative low output state. The indication for surgery also had a significant role in patients' outcome. Mortality found significantly higher in cases operated due to endocarditis or mitral mechanical valve thrombosis compared to other reoperation groups.
  
  
  CONCLUSIONS
  Patients over age of 70 years, with a left atrial diameter over 60 mm, reoperated due to endocarditis and mechanical valve thrombosis, should be reevaluated for risk assessment while giving the decision of optimal operation timing. Especially patients with left ventricular hypertrophy and decreased myocardial reservoirs, efficient myocardial protection during the operation had an important role.
authors.affiliation: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. sebnemal@yahoo.com
authors.forename: S C
authors.initials: SC
authors.lastname: Albeyoglu
authors.forename: U
authors.initials: U
authors.lastname: Filizcan
authors.forename: M
authors.initials: M
authors.lastname: Sargin
authors.forename: M
authors.initials: M
authors.lastname: Cakmak
authors.forename: O
authors.initials: O
authors.lastname: Goksel
authors.forename: O
authors.initials: O
authors.lastname: Bayserke
authors.forename: B
authors.initials: B
authors.lastname: Cinar
authors.forename: E
authors.initials: E
authors.lastname: Eren
mesh_terms: D000328:Adult; D000367:Age Factors; D002303:Cardiac Output, Low / Q000453:epidemiology; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D009017:Morbidity; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D012307:Risk Factors