title: Does the number of redo mitral valve replacements for structural valve deterioration affect early and late outcomes?: experience from 114 reoperative cases.
abstract: OBJECTIVE
  Whether the number of reoperative mitral valve replacements (MVRs) for structural valve deterioration (SVD) affects early or late survival is unclear. Hence, the aim of the present study was to investigate this issue.
  
  
  METHODS
  A total of 114 consecutive patients (84 females, 30 males; mean age 63.4 +/- 11.9 years) who underwent 141 redo MVRs for SVD during a 20-year period was retrospectively analyzed. Of these patients, 87 (76.3%) had undergone first-time reoperations (87 redos; group A), while the remaining 27 (23.7%) had undergone two or more reoperations (54 redos; group B). The mean follow up period was 8.5 +/- 6.8 years, and the follow up rate was 96.2%.
  
  
  RESULTS
  NYHA functional class III or IV was noted in 34 patients (39.1%) of group A, and in 17 patients (63.0%) of group B (p = 0.0292). The EuroSCORE and logistic EuroSCORE in group B were significantly higher than those in group A. The hospital mortality rate was 4.6% in group A and 11.1% in group B (p = 0.1430). Logistic regression analysis revealed risk factors for hospital mortality to be the number of reoperations (OR 4.399; p = 0.0467) and NYHA class III or IV (OR 9.090; p = 0.0483). There were no significant differences in five-, 10- or 15-year survival rates between groups A and B (log-rank test, p = 0.3369). A Cox regression analysis showed advanced age to be the only predictor of late mortality (HR = 1.098; p = 0.0013).
  
  
  CONCLUSIONS
  Irrespective of whether a patient has undergone two or more reoperative MVRs, a better long-term survival can be expected before progression of the patient's NYHA functional class.
authors: Naoto
authors: N
authors: Fukunaga
authors: Yukikatsu
authors: Y
authors: Okada
authors: Yasunobu
authors: Y
authors: Konishi
authors: Takashi
authors: T
authors: Murashita
authors: Tadaaki
authors: T
authors: Koyama
mesh_terms: D000368:Aged; D018450:Disease Progression; D061345:Early Medical Intervention / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D011475:Prosthesis Failure / Q000209:etiology*; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index