Abstract
BackgroundReoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR.MethodsAmong 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR.ResultsHospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 ± 0.3 vs. 1.6 ± 0.3 cm2, p < 0.01). The mean pressure gradient was greater (15.2 ± 6.4 vs. 12.7 ± 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 ± 0.26 vs. 1.06 ± 0.36 cm2/m2, p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups.ConclusionsThe clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves.
Highlights
Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR
Patients with a previous AVR who undergo reoperation are regarded as Tsubota et al Journal of Cardiothoracic Surgery (2020) 15:53 being at higher risk of a prosthesis-patient mismatch (PPM), due to annular fibrosis and restriction after prosthesis extraction; no evidence has been published on the incidence of prosthesis-patient mismatches (PPM) after repeat AVR (re-AVR)
The reference effective orifice areas (EOA) of implanted prosthetic valves at re-AVR was smaller than that of prosthetic valves at previous AVR, the mean pressure gradient was higher, and the Indexed EOA (EOAI) was lower after re-AVR than after primary AVR
Summary
Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. The prevalence of reoperative aortic valve replacement (AVR) after prior cardiac surgery is increasing due to increased survival rates and lifespans. A trend towards implantation with bioprostheses means that more patients will need to undergo repeat AVR Patients with a previous AVR who undergo reoperation are regarded as Tsubota et al Journal of Cardiothoracic Surgery (2020) 15:53 being at higher risk of a prosthesis-patient mismatch (PPM), due to annular fibrosis and restriction after prosthesis extraction; no evidence has been published on the incidence of PPM after re-AVR. Transcatheter aortic valve-in-valve (VIV) implantation has emerged as a less invasive option for destroyed bioprostheses with SVD, and the early outcomes of transcatheter aortic VIV implantation are favorable [2,3,4], the incidence of PPM is high [2]
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