title: Third-time aortic valve replacement: patient characteristics and operative outcome.
abstract: BACKGROUND
  Reoperative cardiac surgery is being performed with increasing frequency. Third-time aortic valve surgery remains a rare procedure. We retrospectively analyzed the outcome of third-time aortic valve replacement (AVR) at our institution.
  
  
  METHODS
  Between 1990 and 2005, 49 patients underwent third-time AVR. Data analyzed included preoperative patient characteristics, type of preexisting aortic valve prosthesis, prosthetic valve pathology necessitating third-time AVR, postoperative morbidity and mortality, and echocardiographic data.
  
  
  RESULTS
  The mean age was 47.4 +/- 17 years. The mean interval between the first and second operation was 8.7 +/- 5.7 years, and between the second and third operation it was 10.2 +/- 5.6 years. Prosthetic valves at the time of second AVR included 32 homografts (65.4%), 11 mechanical prostheses (22.4%), and 6 xenografts (12.2%). At third-time AVR, 29 patients (59.2%) received a homograft or autograft, 12 (24.5%) received a mechanical valve, and 8 (16.3%) received a xenograft. In-hospital mortality was 4.1%. The mean follow-up was 80 +/- 69 months. Freedom from reoperation was 84% +/- 6% at 5 years and 65% +/- 11% at 10 years. Long-term survival was 79% +/- 6% at 5 years and 73% +/- 7% at 10 years. Multivariate analysis showed that age, female sex, and postoperative high left ventricular mass were factors associated with decreased long-term survival. Mean left ventricular mass decreased from 320 +/- 133 g to 263 +/- 102 g at 1 year postoperatively (p = 0.01).
  
  
  CONCLUSIONS
  Third-time AVR can be performed with low operative mortality, low cumulative operative mortality, and satisfactory long-term survival and freedom from reoperation. The procedure results in significant regression of left ventricular mass.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
authors.forename: Kasra
authors.initials: K
authors.lastname: Shaikhrezai
authors.forename: Giordano
authors.initials: G
authors.lastname: Tasca
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Gilles
authors.initials: G
authors.lastname: Dreyfus
authors.forename: George
authors.initials: G
authors.lastname: Asimakopoulos
mesh_terms: D000328:Adult; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D002423:Cause of Death; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000401:mortality / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis