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The Annals of Thoracic Surgery, Vol 50, 590-596, Copyright © 1990 by The Society of Thoracic Surgeons
S Pansini, G Ottino, PG Forsennati, G Serpieri, G Zattera, R Casabona, M di Summa, M Villani, GA Poletti and M Morea
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 reoperative 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.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Reoperations on heart valve prostheses: an analysis of operative risks and late results
Department of Cardiac Surgery, University of Torino, Italy.
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