title: Risk of reoperation for mitral bioprosthesis dysfunction.
abstract: OBJECTIVE
  Today, when a mitral valve replacement is required, more patients and surgeons choose a bioprosthesis. Yet, the rationale of this choice is unclear in patients in whom age represents a predicting factor for reoperation. The study aim was to define the risk factors for reoperation after mitral bioprosthesis failure.
  
  
  METHODS
  A total of 282 consecutive patients (202 women, 80 men; mean age at surgery 61 years; range: 28-88 years) who underwent reoperation for mitral bioprosthesis failure between 1990 and 2006 was reviewed. Surgery was undertaken because of bioprosthesis degeneration (91%), prosthetic valve infective endocarditis (6%), paravalvular leak (2%), or other causes (1%). Emergency procedures were performed in 7% of cases. Associated procedures included tricuspid valve surgery in 16% of patients (tricuspid valve repair in 11%, tricuspid valve replacement in 5%) and coronary artery bypass graft in 5%. Almost one-fifth of patients (18%) had undergone more than one previous mitral valve replacement.
  
  
  RESULTS
  The overall operative mortality was 7.4% (n = 21). Factors identified (by multivariate analysis) as predictors of operative death included: presence of diabetes mellitus (odds ratio (OR) = 8.69, 95% CI 2.55-29.61; p = 0.001), chronic obstructive pulmonary disease (OR = 9.01, 95% CI 1.72-47.18; p = 0.009), NYHA class III/IV (OR 5.46, 95% CI 1.41-21.16; p = 0.01), and pulmonary artery pressure > 60 mmHg (OR = 3.13, 95% CI 1.10-8.94; p = 0.03). Associated procedures were not significant risk factors for mortality. New prostheses were mechanical in 68% of cases, and bioprostheses in 32%.
  
  
  CONCLUSIONS
  One reoperation for mitral bioprosthesis dysfunction is acceptable if the patient can be expected to survive to reoperation while free from comorbidities and the severe effects of mitral disease. The application of strict selective criteria to recipients at the first valve replacement, combined with a close follow up, may allow this goal to be achieved.
authors.affiliation: Service de Chirurgie Cardiaque, Hôpital de la Timone, Marseille, France. nicolas.jaussaud@ap-hm.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jaussaud
authors.forename: Vlad
authors.initials: V
authors.lastname: Gariboldi
authors.forename: Dominique
authors.initials: D
authors.lastname: Grisoli
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.forename: François
authors.initials: F
authors.lastname: Kerbaul
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects*; D015150:Echocardiography, Doppler / Q000379:methods; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D018579:Patient Selection; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D016896:Treatment Outcome