Reoperations on heart valve prostheses: An analysis of operative risks and late results

Abstract

To evaluate risks and complications of reoperations on heart valve prostheses, we reviewed data on 183 patients who underwent reoperation because of prosthetic valve malfunction. The incremental effect of the redo procedure on hospital mortality and morbidity was studied by comparing primary and reoperatiye procedures and analyzing a series of possible predisposing factors. Late survival after first and second reoperations was computed, and possible determinants of late mortality were examined. Overall operative mortality was 8.7%; emergency operation ( p = 0.0001), previous thromboembolism ( p = 0.05), and advanced New York Heart Association functional class ( p = 0.031) were the independent determinants. In a series of 1,355 patients having primary or secondary isolated valve replacement, the redo procedure was a significant risk factor in the univariate analysis ( p = 0.025) but not in the multivariate analysis except for the subset of patients having mitral valve replacement ( p = 0.052). The postoperative course was quite complicated, as evidenced by the long mean stay in the intensive care unit (mean stay, 3.8 days; longer than 2 days for 26% of the survivors). Nevertheless, postoperative complications were not significantly greater after a redo procedure than after a primary operation. Actuarial survival at 7 years was 57.3% ± 8%. A comparison with a nonhomogeneous series from our institution did not demonstrate significant differences. In the subset of 16 patients having a second reoperation, late survival was 37.8% ± 16% at 2 years. Advanced New York Heart Association class ( p = 0.0001), double prosthetic valve dysfunction ( p = 0.003), and any indication other than primary tissue failure ( p = 0.06) were determinants of late mortality. The surgical risk of reoperation on heart valve prostheses is higher than that of the primary operation, but there is no conclusive evidence that the difference is statistically significant. Life expectancy may be reduced, but late survival can be improved if conditions leading to myocardial damage are prevented, ie, reoperation is prompt when necessary.