Bioprosthetic replacement after bioprosthesis failure: A hazardous choice?

Background. Following bioprosthetic failure, replacement is usually done wi th mechanical valves to avoid repeated reoperations. Methods. From 1986 to 1996 we operated on 130 patients with bioprosthetic f ailure, implanting a new bioprosthesis; this group included patients with c ontraindication to anticoagulation, tricuspid replacement, and specific pat ient requests. Mean age was 63 +/- 8 years. Results. The perioperative mortality was 13.8%. At 10 year follow-up the ac tuarial estimate of survival was 77.4% +/- 6.6%. Freedom from structural va lve deterioration was estimated at 81.8% +/- 6.3%. Freedom from a third ope ration was estimated at 85.5% +/- 5.2%. No patient was permanently anticoag ulated. Freedom from thromboembolism was estimated at 91.5% +/- 4%, and the re were no hemorrhages. Freedom from cardiac-related deaths was estimated a t 85.7% +/- 5%. Conclusions. This group of patients received the first valve between 1976 a nd 1986; the range of the cumulative follow-up reaches 20 years, and the ex tended survival compares favorably with survival of mechanical valves. (C) 1998 by The Society of Thoracic Surgeons.