title: Outcomes of reoperative aortic valve replacement after previous sternotomy.
abstract: OBJECTIVE
  Increasingly, patients with previous sternotomy require aortic valve replacement. We compared outcomes of reoperative aortic valve replacement after previous sternotomy and primary aortic valve replacement by surgical era. Effect of initial cardiac operation on reoperative aortic valve replacement was also investigated.
  
  
  METHODS
  Between January 1996 and December 2007, a total of 1603 patients undergoing elective aortic valve replacement were entered prospectively into our clinical database. Patients were divided into eras A (1996-1999), B (2000-2003), and C (2004-2007). A total of 191 patients (12%) had previous sternotomy for coronary artery bypass grafting (n = 88), coronary artery bypass grafting with aortic valve replacement (n = 16), aortic valve replacement with or without other aortic procedure (n = 70), and other cardiac procedures (n = 17). Mean ages were 66.5 +/- 13.1 years in reoperative group and 65.5 +/- 14.9 years in primary group.
  
  
  RESULTS
  Mortality in reoperative group decreased significantly with time (A 15.4% vs B 15.1% vs C 2.0%, P = .004) and was equivalent to primary group in era C (3.5% vs 2.0%, P = .65). Major complications also significantly decreased with time in reoperative group (A 25.6% vs B 17.0% vs C 6.1%, P = .006). Importantly, patients had more comorbidities with time and increased preoperative risk in era C. There were no differences in outcome by initial cardiac operation in reoperative group.
  
  
  CONCLUSIONS
  Reoperative aortic valve replacement now carries similar morbidity and mortality to primary replacement. Risk of reoperation is not affected by primary operation.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.forename: Zequan
authors.initials: Z
authors.lastname: Yang
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome