PROGNOSIS AND RESULTS OF REOPERATION FOR PROSTHETIC VALVE-REPLACEMENT

In order to determine the prognosis of reoperation for valvular replac ement, we reviewed the results of a consecutive series of 124 patients operated in the department between 1974 and 1992 (163 multi redo oper ations). There were 69 women and 55 men, with a mean age 48 years; 77 % of the patients were in functional class III or IV. Operations were performed as an emergency in 30 % of cases. Endocarditis was found in 24 % of cases and was an important risk factor in this content. The ma in indications for reoperation were periprosthetic leakage in 28.8 % o f cases and failure of bioprostheses in 23,7 %. The valvular replaceme nt was simple in 61 %, double in 32 % and triple in 7 % of cases. An a ssociated procedure was necessary in 27 % of cases. Mechanical devices were implanted in 62,3 % of cases. Peroperative mortality was 3 % and hospital mortality, mainly from cardiac causes, was 21,7 % for the se cond, 20 % for the third and 55,6 % for the fourth reoperations. Opera tive mortality was dependent on the number or reoperations, functional class, emergency surgery, duration of bypass and cross-clamping time. Four per cent of patients were lost to follow-up and 30 patients died secondarily. The actuarial survival rate was 52 % at 5 years and 33 % at 10 years, actuarial survival rate without valvular complication wa s 41 % at 5 years and 19 % at 10 years but the functional results rema ined good with over 90 % of patients in functional class I or II at th e end of follow-up.