Original article
Cardiovascular
Repeat Valvular Operations: Bench Optimization of Conventional Surgery

https://doi.org/10.1016/j.athoracsur.2005.11.030Get rights and content

Background

Repeat heart valve operations have become a quite common procedure. We reviewed our experience with reoperative valvular surgery during a 6-year period to assess the risk factors affecting in-hospital mortality and medium-term survival.

Methods

A series of 316 redo procedures performed on a total of 290 patients in the period between 1997 and 2002 at our institution was retrospectively analyzed. Univariate and multivariable analyses were performed.

Results

In-hospital mortality was 3.8%; overall mortality at the end of a 30-month follow-up was 9.3%. We identified advanced New York Heart Association class, advanced age, depressed ejection fraction, emergent or urgent presentation, impairment of renal function, and involvement of tricuspid valve as predictors of mortality. In contrast, duration of cardiopulmonary bypass and multiple valve procedure were not associated with increased short-term risk.

Conclusions

The present study is characterized by particular attention in reducing confounding variables and biases correlated to heterogeneities. The main determinants of mortality are related to the degree of patients’ illness rather than to inherent technical factors of reoperations. Although highest-risk individuals (previous coronary artery bypass grafting or coexistence of aortic aneurysm) were excluded from the study, our data suggest that patients undergoing isolated redo valvular procedures now face operative risks that are comparable to primary intervention.

Section snippets

Material and Methods

Hospital records of 316 consecutive HVR procedures were retrospectively analyzed. Patients were selected from the pool of 780 overall redo procedures performed at our institution in the 1997 through 2002 period, according to the following inclusion criteria: (1) use of full median sternotomy plus normothermic or hypothermic cardiopulmonary bypass; and (2) use of the same surgical strategy at first intervention.

All interventions were performed by the same surgical team. Patient characteristics

Results

Two hundred ninety patients who underwent a total of 316 HVR procedures were included in the present study. In the same period 1,508 isolated valvular procedures were performed in our unit. Baseline features of the population and comorbidity profile are presented in Table 1. Eleven patients (3.8%) had undergone a failed valve repair at first cardiac procedure. One hundred sixty-four patients (56%) underwent one HVR only, 76 patients (26%) underwent two HVRs, 48 patients (14%) underwent three

Comment

Redo interventions have been traditionally associated with high surgical risk and major challenges for the surgeon compared with a primary procedure. This could be partially ascribed to the frequently severe conditions leading to redo procedure. The majority of deaths in recent series are because of cardiac causes, especially myocardial failure, which reflects the severely compromised hemodynamic conditions of the patients presently undergoing HVRs. Specific technical features must be taken

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