Key result
Re-do aortic valve surgery is linked to ~4% in-hospital mortality even in complex cases.
Why the study?
Re-do aortic valve surgery carries higher mortality and morbidity than primary AVR and often requires complex concomitant procedures, while TAVR is an option only for selected patients.
Observational (n=80)
Re-do aortic valve surgery can be performed with acceptable in-hospital mortality (3.8%) in specialized centers, remaining a crucial option for young patients and those with complex anatomy contraindicated for TAVR.
Supports re-do AVR feasibility in specialized centers; leaves open need for randomized TAVR comparisons.
Objectives: Re-do aortic valve surgery carries a higher mortality and morbidity compared with first time aortic valve replacement (AVR) and often requires concomitant complex procedures. Transcatheter aortic valve replacement (TAVR) is an option for selective patients. The aim of this study is to present our experience with re-do aortic valve procedures and give an insight into the characteristics of these patients and their outcomes. Methods: Retrospective review of 80 consecutive re-do aortic valve procedures. Results: Mean patients' age was 51.80±18.73 years. Aortic regurgitation (AR) was present in 51 (65.4%) patients and aortic stenosis (AS) in 38 (48.7%). Indications for reoperation were: infective endocarditis (IE) (23.8%), bioprosthetic degeneration (12.5%), mechanical valve dysfunction (5%), paravalvular leak (6.2%), patient-prosthesis mismatch (3.8%), native valve disease (25%), aortic aneurysm, pseudoaneurysm and dissection (35%), aortic root/homograft degeneration (27.5%). Forty-one (51.2%) patients underwent re-do AVR, 39 (48.8%) re-do complex aortic valve surgery (28 root, 23 ascending aorta and 6 hemiarch procedures) and 37.5% concomitant procedures. A bioprosthesis was implanted in 43.8%, a mechanical valve in 37.5%, a composite graft in 2.5%, a Biovalsalva graft in 6.2% and a homograft in 10% of patients. In-hospital mortality was 3.8% and incidence of major complications was low. Conclusions: A significant proportion of patients were young (61%<60 y), required complex aortic procedures (49%) or presented with contraindications for TAVR (mechanical valve, AR, IE, proximal aortic disease, need for concomitant surgery). Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptable mortality and morbidity in a specialised aortic centre.
No takes yet. Share an insight, caveat, or question.
Greco et al. (2020) conducted an observational in Re-do aortic valve disease (n=80). Re-do aortic valve surgery was evaluated on In-hospital mortality. Re-do aortic valve surgery in 80 consecutive patients, many requiring complex procedures, was associated with an in-hospital mortality of 3.8%.
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: