title: Outcomes of patients undergoing third-time aortic or mitral valve replacement.
abstract: OBJECTIVE
  Third-time valve surgery is rare and to date little is known about the surgical outcome. We reviewed our experience with third-time aortic valve replacement (AVR) and third-time mitral valve replacement (MVR) during an eight-year period.
  
  
  METHODS
  From 2001 to 2013, 32 patients were referred for third-time AVR or third-time MVR to our institution. In this retrospective analysis, patients were evaluated for postoperative morbidity including: hemodialysis, cerebrovascular event, pacemaker implantation, and 30-day and mid-term mortality.
  
  
  RESULTS
  Third-time replacement was for failed aortic valves in 20 (62.5%) patients and for failed mitral valves in 12 (37.5%) patients. Patients' mean age at the time of surgery was 56.3 ± 19 years. The mean interval between the first and the second procedure was 10 ± 7.8 years and between second and third replacement 7.3 ± 5.6 years. The failed prostheses included nine (28%) bioprostheses and 23 (72%) mechanical prostheses. The reasons for replacement were: infective valve endocarditis (31.3%), prosthesis dysfunction (37.3%), and paravalvular leakage (26%). The 30-day mortality was 18.8% and during follow-up was 31.3%. Hemodialysis was needed for eight patients (25.8%), pacemaker implantation for eight patients (25.8%), and cerebrovascular event occurred in four patients (13.3%). In patients with prosthetic valve endocarditis (n = 10), 30-day and overall mortality were 11.1% and 30%, respectively.
  
  
  CONCLUSIONS
  Third-time aortic or mitral valve replacement is a rare procedure but accompanied with high morbidity and mortality, especially in patients with prosthetic valve endocarditis.
authors.affiliation: Clinic for Cardiovascular Surgery, German Heart Center, Munich, Germany.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.forename: Ralf
authors.initials: R
authors.lastname: Günzinger
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Catalin Constantin
authors.initials: CC
authors.lastname: Badiu
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004696:Endocarditis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011475:Prosthesis Failure / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome