title: Contemporary Outcomes of Repeat Aortic Valve Replacement: A Benchmark for Transcatheter Valve-in-Valve Procedures.
abstract: BACKGROUND
  Reoperative aortic valve replacement (re-AVR) after previous AVR is a complex procedure involving redo sternotomy and removal of a previous prosthesis. With increasing use of valve-in-valve transcatheter aortic valve replacement for failed aortic bioprostheses, an evaluation of contemporary outcomes of re-AVR in patients with bioprostheses is warranted.
  
  
  METHODS
  The study included 3,380 patients from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to September 2013) who underwent elective, isolated re-AVR after a previous AVR. Outcomes in these patients were compared with those of 54,183 patients with isolated primary AVR during the same period. A subgroup analysis of explanted bioprostheses in re-AVR (previous bioprosthetic valve: n = 2,213) was performed.
  
  
  RESULTS
  Re-AVR patients were younger (66 vs 70 years, p < 0.001) compared with primary AVR patients. Re-AVR was associated with higher operative mortality (4.6% vs 2.2%, p < 0.0001), composite operative mortality and major morbidity (21.6% vs 11.8%, p < 0.0001), postoperative stroke (1.9% vs 1.4%, p = 0.02), postoperative aortic insufficiency mild or greater (2.8% vs 1.7%, p < 0.0001), pacemaker requirement (11.0% vs 4.3%, p < 0.0001), and vascular complications (0.06% vs 0.01%, p = 0.04). For the explanted previous bioprosthetic valve group, operative mortality was 4.7%, composite outcome was 21.9%, stroke rate was 1.8%, and pacemaker requirement was 11.5%.
  
  
  CONCLUSIONS
  Re-AVR is now performed with an acceptable operative mortality, which is higher than primary AVR. The overall incidence of stroke, vascular complication, and postoperative aortic insufficiency was low although higher than primary AVR. These results may serve as a benchmark for future analysis of valve-in-valve transcatheter aortic valve replacement and may have an effect on future choice of transcatheter aortic valve replacement vs re-AVR.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian
authors.initials: B
authors.lastname: Englum
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Maroun
authors.initials: M
authors.lastname: Yammine
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brennan
authors.affiliation: Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Cardiothoracic Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: saranki@partners.org.
authors.forename: Sary
authors.initials: S
authors.lastname: Aranki
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome