Decrease in operative risk of reoperative valve surgery

Lawrence H. Cohn, Sary F. Aranki, Robert J. Rizzo, David H. Adams, Kimberly A. Cogswell, Nancy M. Kinchla, Gregory S. Couper, John J. Collins

Research output: Contribution to journalArticlepeer-review

87 Scopus citations

Abstract

We analyzed the risk of valve re-replacement in 640 patients reoperated on between 1980 and 1992. This represented 17% of total valve operations ( 640 3,764) 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 12 73 (16%) in 1980 through 1982 to 23 268 (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.

Original languageEnglish
Pages (from-to)15-21
Number of pages7
JournalAnnals of Thoracic Surgery
Volume56
Issue number1
DOIs
StatePublished - Jul 1993
Externally publishedYes

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