PMID- 10579733
OWN - NLM
STAT- MEDLINE
DCOM- 20000525
LR  - 20220316
IS  - 0828-282X (Print)
IS  - 0828-282X (Linking)
VI  - 15
IP  - 11
DP  - 1999 Nov
TI  - Determinants of hospital survival following reoperative single valve replacement.
PG  - 1207-10
AB  - OBJECTIVE: To determine the indicators of risk for hospital death, patients 
      undergoing reoperative valve replacement were analyzed METHODS: Four hundred and 
      eighteen consecutive patients undergoing reoperative valve replacement from 1977 
      to 1994 were reviewed using univariate and multivariate analysis. RESULTS: 
      Overall hospital mortality was 11.2% with 9.4% mortality with aortic valve 
      replacement and 14.2% with mitral valve replacement (P=0.52). Mortality was 9.7% 
      for patients less than 70 years of age compared with 19.4% for older patients 
      (P=0.03), and was 8.5% for those with anoxia times less than 90 mins versus 21.9% 
      for those with longer anoxia times (P=0.001). For first reoperations, 9.5% of 
      patients died, while for patients undergoing second or more reoperation, 
      mortality was 23.2% (P=0.01). While mortality increased from 8.9% to 19.0% with 
      the addition of a concomitant procedure (P=0.008), it was not affected if the 
      additional procedure was a coronary bypass (P=0. 96). The indication for surgery 
      influenced outcome. Mortality was zero for thromboembolism, 9% for structural 
      failure, 23% for nonstructural failure and 22% for endocarditis (P=0.006). For 
      New York Heart Association (NYHA) functional class I patients, mortality was 1.6% 
      compared with 22.3% for those in NYHA class IV (P=0.006). By multivariate 
      analysis, however, only the indication for surgery and the NYHA functional class 
      influenced survival. CONCLUSIONS: Reoperative valve surgery can be performed with 
      a survival (88.8%) that is similar to the initial procedure (91.2%). The 
      indication for surgery and NYHA functional class alone influenced outcome; 
      therefore, possible early reoperation is indicated before clinical deterioration 
      occurs.
FAU - Gill, I S
AU  - Gill IS
AD  - University of Ottawa Heart Institute, Ottawa, Canada.
FAU - Masters, R G
AU  - Masters RG
FAU - Pipe, A L
AU  - Pipe AL
FAU - Walley, V M
AU  - Walley VM
FAU - Keon, W J
AU  - Keon WJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - Aged
MH  - Aortic Valve/*surgery
MH  - Cause of Death
MH  - Female
MH  - Heart Valve Diseases/mortality/surgery
MH  - Heart Valve Prosthesis Implantation/*mortality
MH  - *Hospital Mortality
MH  - Humans
MH  - Intraoperative Complications/mortality
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Ontario/epidemiology
MH  - Postoperative Complications/mortality
MH  - Reoperation/mortality
MH  - Retrospective Studies
MH  - Survival Rate
EDAT- 1999/12/01 09:00
MHDA- 2000/06/08 09:00
CRDT- 1999/12/01 09:00
PHST- 1999/12/01 09:00 [pubmed]
PHST- 2000/06/08 09:00 [medline]
PHST- 1999/12/01 09:00 [entrez]
PST - ppublish
SO  - Can J Cardiol. 1999 Nov;15(11):1207-10.