title: Characteristics and Outcomes of Patients With Severe Bioprosthetic Aortic Valve Stenosis Undergoing Redo Surgical Aortic Valve Replacement.
abstract: BACKGROUND
  With improved event-free survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. We sought to (1) identify of the characteristics of patients with severe bioprosthetic PAS undergoing redo AVR, and (2) assess the outcomes of these patients, along with factors associated with adverse outcomes.
  
  
  RESULTS
  We studied 276 patients with severe bioprosthetic PAS (64±16 years, 58% men) who underwent redo-AVR between 2000 and 2012 (excluding mechanical PAS, severe other valve disease, and transcatheter AVR). Society of Thoracic Surgeons score was calculated. Severe PAS was defined as AV area <0.8 cm(2), mean AV gradient ≥40 mm Hg, or dimensionless index <0.25. A composite outcome of death and congestive heart failure admission was recorded. Mean Society of Thoracic Surgeons score and mean AV gradients were 8±8 and 53±17 mm Hg, whereas 28% had >II+ aortic regurgitation. Only 39% had an isolated redo AVR, the rest were combination surgeries (coronary bypass and/or aortic surgeries). At 4.2±3 years, 64 (23%) patients met the composite end point (48 deaths and 19 congestive heart failure admissions, 2.5% 30-day deaths). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio, 1.35), higher grades of aortic regurgitation (hazard ratio, 1.29), and higher right ventricular systolic pressure (hazard ratio, 1.3) were associated with worse longer-term outcomes (all P<0.01).
  
  
  CONCLUSIONS
  At an experienced center, in patients with severe bioprosthetic PAS undergoing redo AVR, the majority undergo combination surgeries but have excellent outcomes.
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Peyman
authors.initials: P
authors.lastname: Naji
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Kenya
authors.initials: K
authors.lastname: Kusunose
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Fadi
authors.initials: F
authors.lastname: Asfahan
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popovic
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: L Leonardo
authors.initials: LL
authors.lastname: Rodriguez
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: From Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, OH. desaim2@ccf.org.
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001705:Bioprosthesis / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000150:complications; D016127:Heart Valve Prolapse / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013599:Systole; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: aortic valve replacement and outcomes; bioprosthetic aortic stenosis