Reoperative cardiac valve surgery: a multivariable analysis of risk factors

P. Biglioli, S. Di Matteo, A. Parolari, C. Antona, V. Arena, A. Sala

Research output: Contribution to journalArticlepeer-review

Abstract

From December 1983 to March 1992, of 1650 patients who underwent a cardiac valve procedure 41 (2.5%) underwent reoperation on prosthetic heart valves. The indications for reoperation were: structural degeneration (13 patients, 32%), non-structural dysfunction (nine patients, 22%), prosthetic valve endocarditis (seven patients, 17%), valve thrombosis (four patients, 10%), native valve pathology (three patients, 7%), aortic ascending pathology (five dpatients, 12%). The hospital mortality rate for mitral vale reoperation was 12% (two of 17) and for reoperation on the aortic prosthesis 26% (five of 19). No deaths occurred for associated mitral and aortic rereplacement (zero of five). The mortality rate for associated procedures was 24% (four of 17) versus 12% (three of 24) for isolated procedures. Preoperative and operative variables were analysed to determine risk factors for hospital mortality. New York Heart Association functional class, ascites, endocarditis and surgical timing had a univariate influence on operative mortality. The pulmonary capillary wedge pressure and preoperative creatinine level were also higher in non-survivors. Elective reoperation had a mortality rate of 7%, while that for emergency procedures was 38%. Multivariable analysis indicated a longer extracorporeal circulation time and the urgent-emergency status as predictors of mortality. Reoperation before severe haemodynamic impairment occurs is recommended.

Original languageEnglish
Pages (from-to)216-222
Number of pages7
JournalCardiovascular Surgery
Volume2
Issue number2
Publication statusPublished - Apr 1994

Keywords

  • heart valve diseases
  • heart valve prosthesis
  • reoperation mortality
  • risk factors
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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