title: The number of valves requiring surgery does not affect early and late survival in redo valvular surgery.
abstract: OBJECTIVE
  The purpose of this study was to determine whether the number of operated valves affects early and late outcomes in redo valvular surgery.
  
  
  METHODS
  We analysed 328 consecutive patients who underwent a total of 431 redo valvular surgeries from January 1990 to December 2010. The mean age was 61.5 ± 13.0 years. The main indication for redo surgery was structural valve deterioration (66.1%). We divided these patients into the redo single valvular surgery group (Group S, n = 175; 231 redo surgeries) and the redo multivalvular surgery group (Group M, n = 153; 201 redo surgeries). The mean follow-up period was 6.4 ± 5.8 years. The follow-up rate for late survival was 98.3%.
  
  
  RESULTS
  The hospital mortality rate was 6.5% in Group S and 7.0% in Group M (P = 0.85). Logistic regression analysis revealed that advanced age and New York Heart Association (NYHA) functional class III or IV were statistically significant independent risk factors for hospital mortality. Re-exploration for bleeding was more likely to occur in Group M than in Group S. The 5- and 10-year survival rates were 84.8 ± 3.0 and 70.8 ± 4.6% in Group S and 82.0 ± 3.5 and 70.2 ± 4.9% in Group M, respectively, with no statistical difference. Cox regression analysis revealed that advanced age, a left ventricular ejection fraction rate of <60% and redo surgery beyond the first redo were independent negative predictors of late mortality. NYHA functional class I or II was a statistically significant positive predictor of late survival.
  
  
  CONCLUSIONS
  The number of valves requiring redo surgery does not negatively impact early or late survival. Mortality is not different whether one or multiple valves need to be tackled in a redo scenario.
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan naotowakimachi@hotmail.co.jp.
authors.forename: Naoto
authors.initials: N
authors.lastname: Fukunaga
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan.
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Konishi
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan.
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Koyama
mesh_terms: D000367:Age Factors; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis
keywords: Number of valves; Redo valvular surgery; Survival