REOPERATION ON PROSTHETIC HEART-VALVES - PATIENT-SPECIFIC ESTIMATES OF IN-HOSPITAL EVENTS

Reoperation on prosthetic heart valves is increasingly under considera tion for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new pe rsisting neurologic deficit, and length of postoperative stay, a three -institution study of 2246 consecutive prosthetic valve reoperations p erformed on 1984 patients between 1963 and 1992 was undertaken. The co mbined experience ranged from high-risk patients coming moribund to th e operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-una djusted hospital mortality was 10.8%, neurologic deficit at hospital d ischarge 1.1%, and length of stay 10 days (median). Multivariably dete rmined correlates of outcome included age at reoperation, degree, seve rity, and acuity of impairment of cardiac function, extensiveness of v alvular heart disease, coexisting morbid conditions, number of previou s heart operations, and concomitant procedures. The risk-adjusted hosp ital mortality for the first elective reoperation in a good-risk patie nt was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0 .3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (90% confidence limits 4 to 13), emphasizing the wide var iance in outcome events. Equations were developed to permit wide appli cation of the results of the study for quantitatively estimating the r isk of outcome events based on individual preoperative patient charact eristics. These estimates should be useful for informed patient consen t, considerations of prophylactic valve replacement, and cost and reso urce use.