PMID- 10731648
OWN - NLM
STAT- MEDLINE
DCOM- 20000519
LR  - 20220309
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 17
IP  - 2
DP  - 2000 Feb
TI  - Reoperative surgery for degenerated aortic bioprostheses: predictors for 
      emergency surgery and reoperative mortality.
PG  - 134-9
AB  - OBJECTIVE: The long-term outcome of patients with aortic bioprosthetic valves 
      could be improved by decreasing the reoperative mortality rate. METHODS: 
      Predictors of emergency reoperation and reoperative mortality were identified 
      retrospectively in 172 patients who had the first bioprosthetic aortic valve 
      replacement between 1975 and 1988 (mean age 46+/-13 years) and were subjected to 
      replacement of the degenerated bioprostheses between 1978 and 1997 (mean age 
      56+/-14 years). Emergency reoperation had to be performed in 31 patients (18%). 
      RESULTS: The operative mortality was 5.2% (9/172), 22.6% for emergency (odds 
      ratio 11.17; 95%-confidence limit 4.33-28.85) and 1.4% for elective replacement 
      of the degenerated aortic bioprosthesis (P<0.0001; OR=20.3). Patients who died at 
      reoperation had higher transvalvular gradients before the primary aortic valve 
      replacement (P=0.007), received smaller bioprostheses at the first operation 
      (P=0.03), had later recurrence of symptoms after the first aortic valve 
      replacement (P=0.04), a higher pre-reoperative New York Heart Association (NYHA) 
      class (P=0.02), and a higher incidence of coronary artery disease (P=0.001) and 
      pulmonary artery hypertension (P=0.009). Endocarditis before the primary aortic 
      valve replacement (P=0.004), postoperative pneumonia at the first operation 
      (P=0.005), pulmonary hypertension (P=0.0004) acquired during the interval, later 
      recurrence of symptoms (P=0.04) after the first operation, a lower ejection 
      fraction at the time of reoperation (P=0.03) and acute onset of bioprosthetic 
      regurgitation (P=0.00002) were predictors for emergency surgery. Higher 
      transvalvular gradients at the primary aortic valve replacement (P=0. 006), 
      coronary artery disease (P=0.003) acquired during the interval, the need for 
      concomitant coronary artery revascularization (P=0. 001), sex (P=0.02) and size 
      (P=0.05) and type of the bioprostheses used (P=0.007) were incremental predictors 
      for reoperative mortality which were independent of emergency surgery. 
      CONCLUSIONS: Elective replacement of failed aortic bioprostheses is safe. 
      Patients undergoing emergency reoperation have a considerably higher mortality. 
      They can be identified by a history of native aortic valve endocarditis, higher 
      transvalvular gradients at primary aortic valve replacement, smaller 
      bioprostheses, and pulmonary hypertension or coronary artery disease acquired 
      during the interval. A failing bioprosthesis must be replaced at its first sign 
      of dysfunction.
FAU - Vogt, P R
AU  - Vogt PR
AD  - Clinic for Cardiovascular Surgery and Cardiology, University Hospital, 
      Ramistrasse 100, CH-8091, Zurich, Switzerland. paul.vogt@chi.usz.ch
FAU - Brunner-LaRocca, H
AU  - Brunner-LaRocca H
FAU - Sidler, P
AU  - Sidler P
FAU - Zund, G
AU  - Zund G
FAU - Truniger, K
AU  - Truniger K
FAU - Lachat, M
AU  - Lachat M
FAU - Turina, J
AU  - Turina J
FAU - Turina, M I
AU  - Turina MI
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aortic Valve
MH  - Aortic Valve Insufficiency/surgery
MH  - Aortic Valve Stenosis/surgery
MH  - *Bioprosthesis
MH  - Emergencies
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prosthesis Failure
MH  - Reoperation/mortality
MH  - Retrospective Studies
EDAT- 2000/03/25 09:00
MHDA- 2000/06/08 09:00
CRDT- 2000/03/25 09:00
PHST- 2000/03/25 09:00 [pubmed]
PHST- 2000/06/08 09:00 [medline]
PHST- 2000/03/25 09:00 [entrez]
AID - S1010794099003632 [pii]
AID - 10.1016/s1010-7940(99)00363-2 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Feb;17(2):134-9. doi: 
      10.1016/s1010-7940(99)00363-2.