Background: Patients undergoing repeat heart valve operations are a diverse
population. We assessed risk factors for operative mortality in patients u
ndergoing a first heart valve reoperation.
Methods: A retrospective review of hospital records was performed for 671 p
atients who underwent first repeat heart valve operations between 1969 and
1998. Univariable and multivariable analyses were performed.
Results: Operative mortality was 8.6%. Mortality fell each decade to 4.8% i
n the most recent period (adjusted chi (2) for linear trend P < .0005). Mor
tality increased from 3.0% for reoperation for a failed repair or reoperati
on at a new valve site to 10.6% for prosthetic valve dysfunction or peripro
sthetic leak and to 29.4% for endocarditis or valve thrombosis. Concomitant
coronary artery bypass grafting was associated with a mortality of 15.4% c
ompared with 8.2% when it was not required. Mortality for aortic valve repl
acement was 6.4%, mitral valve replacement 7.4%, aortic and mitral valve re
placement 11.5%, tricuspid valve replacement 25.6%, periprosthetic leak rep
air 9.1 %, and isolated valve repair 2.2%. Among 336 patients requiring rep
lacement of prosthetic valves, mortality was 26.1 % for replacement of a me
chanical valve compared with 8.6% for replacement of a tissue valve (P < .0
005). Multivariable analyses identified year of reoperation, age, coronary
artery bypass grafting, indication, and replacement of a mechanical valve r
ather than a tissue valve as significant explanatory variables for operativ
e mortality.
Conclusions: Heart valve reoperations can be performed with an acceptable o
perative mortality. However, we have identified several categories of patie
nts in whom reoperation carries an increased risk.