title: Risk of reoperation for aortic bioprosthesis dysfunction.
abstract: OBJECTIVE
  The risk of reoperative valve replacement for failed aortic bioprosthesis may be overestimated, this being a dominant factor when selecting an initial prosthesis to be implanted in patients aged <70 years. The study aims were, first, to analyze the mortality and morbidity of redo aortic bioprosthesis replacement in the current era, and second, to identify preoperative risk factors and evaluate the EuroSCORE.
  
  
  METHODS
  A total of 156 consecutive patients (111 men, 45 women; mean age 60.9 years; range: 23-87 years) who underwent reoperation for failed aortic bioprosthesis between 1990 and 2006 was reviewed in this retrospective, single-center study. Surgery was undertaken due to bioprosthesis degeneration (82.7%), bacterial prosthetic endocarditis (14.1%), paravalvular leak (1.3%) and other causes (1.9%). Emergency procedures were performed in 9% of patients. Associated procedures were coronary artery bypass grafting in 7.7% of patients, ascending aortic graft in 7%, and complete aortic root replacement in 6.4%. The predictive mortality was 8% according to the Additive EuroSCORE, and 15% according to the Logistic EuroSCORE.
  
  
  RESULTS
  Overall, the operative mortality was 3.8% (n = 6), and postoperative morbidity was low. The only multivariable predictor was emergency surgery (OR = 15.22, 95% CI = 1.68-86.43; p = 0.02). A mortality trend was associated with atrial fibrillation and NYHA class III/IV, but this was not statistically significant (p = 0.09 and p = 0.06, respectively). Associated procedures were not significant risk factors for mortality.
  
  
  CONCLUSIONS
  Reoperation for aortic bioprosthesis dysfunction can be performed with a low risk of mortality. It appears that this risk is overestimated by the EuroSCORE. Those patients who wish to avoid postoperative anticoagulant therapy may choose to receive this type of valve, even if reoperation is foreseeable.
authors: Department of Cardiac Surgery, Timone University Hospital, Marseille, France. nicolas.jaussaud@ap-hm.fr
authors: Nicolas
authors: N
authors: Jaussaud
authors: Vlad
authors: V
authors: Gariboldi
authors: Roch
authors: R
authors: Giorgi
authors: Dominique
authors: D
authors: Grisoli
authors: Virginie
authors: V
authors: Chalvignac
authors: Franck
authors: F
authors: Thuny
authors: Alberto
authors: A
authors: Riberi
authors: Frederic
authors: F
authors: Collart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery; D001705:Bioprosthesis; D000075202:Contraindications; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome