PMID- 29293911
OWN - NLM
STAT- MEDLINE
DCOM- 20190429
LR  - 20190429
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 53
IP  - 6
DP  - 2018 Jun 1
TI  - Multiple reoperations on the aortic valve: outcomes and implications for future 
      potential valve-in-valve strategy.
PG  - 1251-1257
LID - 10.1093/ejcts/ezx469 [doi]
AB  - 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.
FAU - Joshi, Yashutosh
AU  - Joshi Y
AD  - Blacktown Hospital, Sydney, NSW, Australia.
FAU - Achouh, Paul
AU  - Achouh P
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
FAU - Menasche, Philippe
AU  - Menasche P
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
AD  - INSERM UMR 970, Paris, France.
FAU - Fabiani, Jean-Noel
AU  - Fabiani JN
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
FAU - Berrebi, Alain
AU  - Berrebi A
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
FAU - Carpentier, Alain
AU  - Carpentier A
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
FAU - Latremouille, Christian
AU  - Latremouille C
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
FAU - Jouan, Jerome
AU  - Jouan J
AD  - Department of Cardiovascular Surgery, Georges Pompidou European Hospital and 
      University Paris-Descartes, Sorbonne Paris-Cite, Paris, France.
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  - Aged
MH  - Aortic Valve/*surgery
MH  - Bioprosthesis
MH  - Female
MH  - Heart Valve Diseases/surgery
MH  - Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation/adverse effects/methods/mortality/statistics 
      & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - *Reoperation/adverse effects/mortality/statistics & numerical data
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2018/01/03 06:00
MHDA- 2019/04/30 06:00
CRDT- 2018/01/03 06:00
PHST- 2017/09/17 00:00 [received]
PHST- 2017/11/28 00:00 [accepted]
PHST- 2018/01/03 06:00 [pubmed]
PHST- 2019/04/30 06:00 [medline]
PHST- 2018/01/03 06:00 [entrez]
AID - 4775057 [pii]
AID - 10.1093/ejcts/ezx469 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2018 Jun 1;53(6):1251-1257. doi: 10.1093/ejcts/ezx469.