RISK OF REOPERATIVE VALVE-REPLACEMENT FOR FAILED MITRAL AND AORTIC BIOPROSTHESES

Background. One factor influencing the choice of mechanical versus bio prosthetic valves is reoperation for bioprosthetic valve failure. To d efine its operative risk, we reviewed our results with valve reoperati on for bioprosthetic valve failure. Methods. Records of 400 consecutiv e patients having reoperative mitral, aortic, or mitral and aortic bio prosthetic valve replacement from January 1985 to March 1997 were revi ewed. Results. Reoperations were for failed bioprosthetic mitral valve s in 219 patients, failed aortic valves in 153 patients, and failed ao rtic and mitral valves in 28 patients. Including 26 operations (6%) fo r acute endocarditis, 153 operations (38%) were nonelective. One hundr ed nine patients (27%) had other valves repaired or replaced, and 72 ( 18%) had coronary bypass grafting. The incidence of death in the mitra l, aortic, and double-valve groups was respectively, 15 (6.8%), 12 (7. 8%), and 4 (14.3%); and the incidence of prolonged postoperative hospi tal stay (> 14 days) was, respectively, 57 (26.0%), 41 (26.8%), and 8 (28.6%). Only 7 of 147 patients (4.8%) having elective, isolated, firs t-time valve reoperation died. Multivariable predictors (p < 0.05) of hospital death were age greater than 65 years, male sex, renal insuffi ciency, and nonelective operation; and predictors of prolonged stay we re acute endocarditis, renal insufficiency, any concurrent cardiac ope ration, and elevated pulmonary artery systolic pressure. Conclusions. Reoperative bioprosthetic valve replacement can be performed with acce ptable mortality and hospital stay. The best results are achieved with elective valve replacement, without concurrent cardiac procedures. (C ) 1998 by The Society of Thoracic Surgeons.