REOPERATION ON PROSTHETIC HEART-VALVES - AN ANALYSIS OF RISK-FACTORS IN 552 PATIENTS

Abstract

Patients (552) underwent a total of 617 reoperations for repair or replacement of a prosthetic heart valve. Operative mortality for 1st reoperation (530 patients) was 5.9% for the aortic position and 19.6% for the mitral position. Overall operative mortality was 14% for 2nd reoperation (69 patients) and 7% for 3rd reoperation (14 patients). In addition to valve position, operative mortality for 1st reoperation appeared to be related to pre-reoperation functional class and urgency of operation. First reoperation for mitral valve patients in New York Heart Association (NYHA) class II was 4.2%; for class III, 9.3%; and for class IV, 41%. In the aortic position, operative mortality was 2.4% for class I, 1.6% for class II, 6.3% for class III and 20.8% for class IV. The mortality for elective mitral valve reoperation was 0%; for urgent operation, 20.3%; and for emergency procedures, 54.5%. Elective aortic valve reoperation carried a 1.4% mortality; urgent procedures, 8%; and emergency procedures, 37.5%. No significant differences in bleeding complications were noted between reoperations and initial valve replacement. Evidently, when significant valve dysfunction is first noted, reoperation should be undertaken to minimize operative risk.