Benchmarking Outcomes: Reoperation for Aortic Valve Patient-Prosthesis Mismatch

Abstract

Surgical reoperations for symptomatic aortic valve patient-prosthesis mismatch (PPM) are complex. The purpose of this research was to investigate the clinical and echocardiographic outcomes of patients who underwent reoperation for correction of symptomatic PPM after prior aortic valve replacement. An institutional review identified 60 patients from 2004 to 2018 who underwent reoperative aortic valve replacement for PPM without structural valve degeneration. Univariate analyses were conducted to evaluate risk factors for perioperative mortality. Median patient age was 62.8 (interquartile range, 48.3-68.7) years, and mean body mass index was 29.2 ± 6.6 kg/m2. Thirty-nine (66%) patients underwent a first-time reoperation, and 18 (30.5%) underwent a second-time reoperation. The median interval between initial operation to reoperation for the treatment of PPM was 89 months. Thirty-four (56.7%) patients underwent aortic root replacement, while the remainder (43.3%) underwent aortic valve replacement. Additional procedures included replacement of the ascending aorta with or without aortic arch in 26 (43.3%) patients and coronary artery bypass grafting in 7 (12%) patients. Operative mortality and the rates of stroke and renal failure were 5.0%, 3.3%, and 5.0%, respectively. Echocardiographic follow-up was available in 64.9% of patients at a mean follow-up of 36.5 months. Preoperative mean pressure gradients were 32.1 ± 16.0 mm Hg and mean aortic valve area was 0.8 ± 0.3 cm2, and both improved to 6.6 ± 4.2 mm Hg and 2.3 ± 0.7 cm2 (P < .001). Reoperative surgery for PPM is complex but may be performed with good outcomes and low mortality in experienced centers. These data provide excellent clinical and hemodynamic benchmarks for the treatment of PPM in the current era of valve-in-valve transcatheter aortic valve replacement.