VALVE REOPERATIONS - IDENTIFICATION OF RISK-FACTORS AND COMPARISON WITH FIRST-TIME OPERATIONS

Fourty-seven patients with a least one heart valve operation each who underwent reoperations (Gr I) were analyzed with special regard to ris k factors influencing the perioperative mortality and compared to 203 patients operated for the first time (Gr. II) during the same time per iod. Mean age was 57.1 years in Gr. I and 64.1 years in Gr. II (p< 0.0 5). There were no differences between the groups with regard to sex, s moking, obesity, or concomitant peripheral vascular disease. Hypertens ion, hyperlipidemia, and diabetes were more frequently seen in Gr. I, p< 0.05. A significantly higher number of patients in the redo group ( Gr. I) belonged preoperatively to NYHA class III or IV, p< 0.001 and n eeded emergency surgery more often, p< 0.01, but left-ventricular func tion did not differ between the groups. There was no significant diffe rence in the position of valves operated or the number of multiple val ve replacements/repairs between the groups, and no difference in aorti c cross-clamping or cardiopulmonary bypass time. Most patients were re ferred from other hospitals. Overall perioperative mortality for Gr I was 6.4 % and Gr. II 4.4% (n.s.). Mortality after first reoperation wa s 5.0 %, after second or more 14.3 %. Perioperative mortality was rela ted to age, preoperative NYHA class, and urgency of operation in both groups, and to multiple valve replacement/repair in Gr. I. Elective re operation carried a mortality of 4.8 % but emergency reoperation 20 %; reoperation mortality was 2.6 % for single valves and 25 % for multip le valves. Morbidity in Gr. I was significantly higher than in Gr. II regarding postoperative low cardiac output, need for prolonged ventila tory support, temporary renal insufficiency, and reexploration for ble eding (all p<0.05). Sternal dehiscence and infection did not differ be tween the groups. Valve reoperations do not have a higher mortality th an first-time valve operation, except for multiple valve surgery, hut carry a slightly increased postoperative morbidity.