RF15 DOES RE-DO AORTIC VALVE SURGERY STILL HAVE A ROLE IN THE ERA OF TRANS-CATHETER AORTIC VALVE IMPLANTATION?

Abstract

Abstract Background and aim: Re-do aortic valve replacements (AVR) have higher mortality and morbidity compared to first time AVR. Trans-catheter aortic valve implantation (TAVI) is an option for high-risk patients. The aim of the study is to present our experience with re-do aortic procedures. Method: Retrospective review of 80 patients (mean age 51.8 ± 18.73) who underwent re-do aortic valve procedures (2008–2017). 41 (51.2%) had re-do AVR and 39 (48.8%) re-do complex aortic surgery (28 root, 23 ascending and 6 hemiarch). Results: Mean Euroscore II was 8.3% (higher in the complex group 12 vs 5%). 19% of patients had a mechanical valve implanted as result of previous surgery. Indication for reoperation was: infective endocarditis in 19 (23.8%) (12 root abscess), bio-prosthesis degeneration in 10 (12.5%), mechanical valve dysfunction in 4 (5%), aortic aneurysm, pseudoaneurysm and dissection in 28 (35%), root/homograft degeneration in 22 (27.5%), patient-prosthesis mismatch in 3 (3.8%), paravalvular leak in 5 (6.2%), native valve disease in 20 (25%). 65.4% of patient had significant AR and 37,5% required concomitant procedures. IH mortality was 2.5% (0% re-do AVR vs 5.1% re-do complex). Conclusion: A large number of patients presented with contraindications for TAVI: age < 60 (61%), previous mechanical valve (18.8%), significant AR (65.4%), infective endocarditis (23.8%), need for complex aortic procedure (49%) or concomitant surgery (37.5%). The number of patients that would actally benefit from TAVI procedures is overestimated. Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptably low mortality and morbidity.