Determinants of hospital survival following reoperative single valve replacement

OBJECTIVE: To determine the indicators of risk for hospital death, patients undergoing reoperative valve replacement were analyzed METHODS: Four hundred and eighteen consecutive patients undergoing reoperat ive valve replacement from 1977 to 1994 were reviewed using univariate and multivariate analysis. RESULTS: Overall hospital mortality was 11.2% with 9.4% mortality with aort ic valve replacement and 14.2% with mitral valve replacement (P = 0.52). Mo rtality was 9.7% for patients less than 70 years of age compared with 19.4% for older patients (P = 0.03), and was 8.5% for those with anoxia times le ss than 90 mins versus 21.9% for those with longer anoxia times (P = 0.001) . For first reoperations, 9.5% of patients died, while for patients undergo ing second or more reoperation, mortality was 23.2% (P = 0.01). While morta lity increased from 8.9% to 19.0% with the addition of a concomitant proced ure (P = 0.008), it was not affected if the additional procedure was a coro nary bypass (P = 0.96). The indication for surgery influenced outcome. Mort ality was zero for thromboembolism, 9% for structural failure, 23% for nons tructural failure and 22% for endocarditis (P = 0.006). For New York Heart Association (NYHA) functional class I. patients, mortality was 1.6% compare d with 22.3% for those in NYHA class IV (P = 0.006). By multivariate analys is, however, only the indication for surgery and the NYHA functional class influenced survival. CONCLUSIONS: Reoperative valve surgery can be performed with a survival (88 .8%) that is similar to the initial procedure (91.2%). The indication for s urgery and NYHA functional class alone influenced outcome; therefore, possi ble early reoperation is indicated before clinical deterioration occurs.