Open redo aortic valve replacement had an overall in-hospital mortality of 7.3%, with no significant difference between first, second, or third reinterventions (P=0.233).
Cohort (n=316)
No
What are the outcomes and risk factors for mortality in patients undergoing open redo operations on the aortic valve?
Open redo aortic valve replacement carries an acceptable risk of early mortality, particularly for structural valve deterioration, providing a benchmark for emerging transcatheter valve-in-valve therapies.
p-value: p=0.233
OBJECTIVES: Surgical mortality and long-term outcomes are important considerations when determining strategies for multiple reoperations on the aortic valve (AV). With the rise of percutaneous valve-in-valve, we sought to evaluate the current outcomes of conventional surgery for AV reoperation, focusing first on the effect of the number of previous AV interventions with a subsequent analysis of the risk factors for adverse outcomes. METHODS: From January 2007 to December 2016, 316 consecutive patients underwent an open redo operation (replacement) on their AV at a single centre. It was the first AV reintervention in 263 patients (Group 1), second in 42 patients (Group 2) and third or more in 11 patients (Group 3). RESULTS: There were 230 men and 86 women, with a median age of 58 (Q1-Q3: 46-70) years. Structural valve deterioration (SVD) of the bioprosthesis (n = 136, 44%), endocarditis (n = 57, 18%) and prosthetic valve dehiscence (n = 41, 13%) were the most common reasons for reintervention. Overall, in-hospital mortality was 7.3%: 7.2% in Group 1, 4.76% in Group 2 and 18.2% in Group 3 (P = 0.233) and ranged from 3.7% for SVD to 14.0% when endocarditis was the reason for reintervention. Higher preoperative New York Heart Association (NYHA) class (III/IV) odds ratio (OR) 15.9, P = 0.011, injury during re-entry (OR 16.9, P = 0.015), endocarditis (OR 3.7, P = 0.038) and concomitant mitral valve replacement (OR 5.6, P = 0.006) were independent risk factors for in-hospital mortality. Survival at 8 years was 79.0 ± 3.0% for the entire cohort and 88.4 ± 3.2% for re-replacement after SVD. CONCLUSIONS: Multiple AV reoperations carry an acceptable risk of early postoperative mortality, particularly for isolated valve replacements of SVD.
Joshi et al. (Thu,) conducted a cohort in Aortic valve reoperation (n=316). Open redo aortic valve replacement vs. Number of previous aortic valve interventions was evaluated on In-hospital mortality (p=0.233). Open redo aortic valve replacement had an overall in-hospital mortality of 7.3%, with no significant difference between first, second, or third reinterventions (P=0.233).
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