PMID- 6975401
OWN - NLM
STAT- MEDLINE
DCOM- 19820109
LR  - 20071114
IS  - 0022-5223 (Print)
IS  - 0022-5223 (Linking)
VI  - 82
IP  - 5
DP  - 1981 Nov
TI  - Hospital mortality of re-replacement of the aortic valve. Incremental risk 
      factors.
PG  - 692-8
AB  - A total of 200 aortic vale re-replacements were performed between Jan. 1, 1975, 
      and July 1, 1979. The re-replacements (RRP) were an isolated procedure or 
      combined with coronary artery bypass grafting or resection of ascending aortic 
      aneurysm. Ten patients (5%) died in hospital, compared with 24 (2.9%) among 842 
      patients undergoing isolated or combined initial aortic valve replacement (AVR) 
      (p = 0.12). The mode of death was cardiac failure in six of the 10 patients, 
      hemorrhage in two (from accidents at repeat sternotomy), and neurologic deficits 
      in two (each with innominate vein transection at repeat sternotomy repaired by 
      ligation). There were seven (3.9%) hospital deaths among 181 first RRP (p for 
      difference from initial AVR = 0.5), but three (15%) of 19 died after the second 
      or third RRP (p = 0.001). By simple contingency table analysis, preoperative New 
      York Heart Association (NYHA) Class IV increased the risk of hospital death after 
      RRP (p = 0.002), as did prosthetic valve endocarditis (p = 0.0005) and the use of 
      cold ischemic arrest (p = 0.03). Logistic multivariate analysis showed advanced 
      NYHA functional class (p = 0.02), use of cold ischemic arrest (p = 0.09), and 
      increased aortic cross-clamps time (p = 0.03) to be incremental risk factors. 
      Recommendations for reducing hospital deaths in the event of RRP are (1) 
      reoperate before severe hemodynamic deterioration occurs, (2) plan and conduct 
      the operation to minimize accidents from repeat sternotomy and dissection, (3) 
      keep aortic cross-clamp time as short as possible, and (4) employ cold 
      cardioplegia.
FAU - Wideman, F E
AU  - Wideman FE
FAU - Blackstone, E H
AU  - Blackstone EH
FAU - Kirklin, J W
AU  - Kirklin JW
FAU - Karp, R B
AU  - Karp RB
FAU - Kouchoukos, N T
AU  - Kouchoukos NT
FAU - Pacifico, A D
AU  - Pacifico AD
LA  - eng
GR  - HL11-310/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
MH  - Aortic Valve/*surgery
MH  - *Coronary Artery Bypass
MH  - Endocarditis, Bacterial/complications
MH  - Heart Arrest, Induced
MH  - Heart Diseases/complications
MH  - Heart Valve Prosthesis/*mortality
MH  - Hemorrhage/complications
MH  - Humans
MH  - Hypothermia, Induced
MH  - Nervous System Diseases/complications
MH  - Postoperative Complications
MH  - Risk
EDAT- 1981/11/01 00:00
MHDA- 1981/11/01 00:01
CRDT- 1981/11/01 00:00
PHST- 1981/11/01 00:00 [pubmed]
PHST- 1981/11/01 00:01 [medline]
PHST- 1981/11/01 00:00 [entrez]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 1981 Nov;82(5):692-8.