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Ann Thorac Surg 1993;56:15-21
© 1993 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, Brigham and Women's Hospital USA
b Department of Surgery, Harvard Medical School, Boston, Massachusetts USA
* Address reprint requests to Dr Cohn, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St. Boston, MA 02115.
We analyzed the risk of valve re-replacement in 640 patients reoperated on between 1980 and 1992. This represented 17% of total valve operations ([equation],764) during that period. A univariate and logistic multivariate analysis was carried out for four sequential periods for the 640 re-replacement patients to determine if changing methods of perfusion and myocardial protection affected recent results. There were 323 female and 317 male patients with a mean age of 58 years (range, 17 to 84 years). Ninety-seven (15%) had coronary artery bypass grafting, 135 (21%) were 70 years old or older, 377 (59%) were in New York Heart Association functional class III or less, and 263 (41%) were in functional class IV. The aortic valve was re-replaced in 245, the mitral valve in 289, and both aortic and mitral synchronously in 106. Four periods were analyzed: 1980 through 1982, 1983 through 1985, 1986 through 1988, and 1989 through 1992. The overall operative mortality was 65 of 640 patients (10%), falling from [equation] (16%) in 1980 through 1982 to [equation] (8%) in 1989 through 1992 (p = 0.05). Univariate and multivariate logistic analysis documented that New York Heart Association functional class was highly significant for operative mortality; operative mortality was 4% for functional classes I through III, and 19% for functional class IV (p 
0.001). The requirement for coronary bypass was of borderline significance (p = 0.05), and year of operation was also significant. Mortality for re-replacement of aortic valve fell from 15% to 10%, double valve from 20% to 9%, and mitral valve from 16% to 6%. Postoperative nonfatal morbidity included rebleeding in 5.6%, stroke in 3.4%, low cardiac output in 7%, and myocardial infarction in 1.3%. With improvement in myocardial protection and cardiopulmonary bypass strategies, the operative risk in patients undergoing valve re-replacement has been markedly reduced.
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