Risk of reoperation for structural failure of aortic and mitral tissue valves

Dalrymple-Hay, Malcolm J.R., Crook, Timothy, Bannon, Paul G., Ohri, Sunil K., Haw, Marcus P., Bayfield, Matthew S., Hendel, Nick P., Livesey, Steven A., Hughes, Clifford F. and Monro, James L. (2002) Risk of reoperation for structural failure of aortic and mitral tissue valves. The Journal of Heart Valve Disease, 11 (3), 419-423.

Abstract

In order to assess the risk of reoperation in the case of a failing stented tissue valve, 259 patients (118 males, 141 females; mean age 60.1 ± 15.4 years) underwent redo valve replacement. Of these patients, 94 (36.3%) underwent redo aortic valve replacement (AVR), 105 (40.5%) redo mitral valve replacement (MVR), and 60 (23.2%) redo aortic and mitral valve replacement (DVR). Twenty patients (7.7%) had previous coronary artery bypass grafting (CABG); further CABG were performed in 32 cases (12.4%). Preoperatively, 216 patients (83.3%) were in NYHA functional class III or IV. Early mortality was (6.5%; n = 17). A higher preoperative NHYA status (p <0.0004) and emergency surgery (p <0.0001) were associated with an increased risk of operative death. Age at operation (p = 0.45), previous CABG (p = 0.45), position of the valve replaced (p = 0.2), type of implant (p = 0.06) and presence of coronary artery disease (p = 0.51) were not associated with a significant risk of operative mortality. A failing tissue valve may be replaced, with acceptable operative mortality and morbidity. The trend towards reducing the age at which tissue valve implantation is performed may be justified.

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