Risk factors for short- and long-term survival in patients undergoing re-replacement due to prosthetic valve dysfunction.
The purpose of this study was to investigate the effect of preoperative, intraoperative, and postoperative variables on early, mid-, and long-term outcome of re-replacement of prosthetic valves. Between February 1989 and January 2004, 192 patients who were treated for prosthetic valve dysfunction were analyzed retrospectively using a computer-based databank system. Prosthetic valve re-replacements were performed, including 164 cases of second, 10 cases of third, and 2 cases of fourth valve re-replacement. The number of re-replacements amounted to 6.1% (n = 176) of total valvular surgery. There were 90 male patients (46.8%) and the mean age was 61.6 +/- 8.3 years. Median follow-up time was 7.8 years. Hospital mortality was 11.7% (n = 14). Low ejection fraction (EF), advanced New York Heart Association (NYHA) functional class, prosthetic valve endocarditis, and pulmonary edema were found to be predictors of early mortality. The 1-, 5-, and 10-year actuarial survival rates were 92% +/- 3%, 78% +/- 3%, and 45% +/- 2%, respectively. Multivariate analysis revealed that NYHA class IV, low EF, prosthetic valve endocarditis, advanced age, left ventricular end-systolic diameter (LVESD) >50 mm, and double valve re-replacement were independent predictors of late mortality. In our study NYHA class IV, low EF, prosthetic valve endocarditis, and LVESD >50 mm were found to be risk factors for both hospital mortality and long-term survival. In addition, pulmonary edema, advanced age, and double valve replacement were also risk factors over the long term. Aggressive treatment of endocarditis and early re-replacement before aggravation of left ventricle function will improve the results.
Oz
Bilgehan Savaş
BS
Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Gülhane Askeri Tip Akademisi, Kalp Damar Cerrahisi, Etlik, Ankara 06018, Turkey.
Iyem
Hikmet
H
Akay
Hakki Tankut
HT
Bolcal
Cengiz
C
Yokusoglu
Mehmet
M
Kuralay
Erkan
E
Demirkilic
Ufuk
U
Tatar
Harun
H
D000367:Age Factors; D000368:Aged; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D016459:Prosthesis-Related Infections / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome