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Outcomes of Patients Undergoing Third‐ T ime Aortic or Mitral Valve Replacement
Author(s) -
Elhmidi Yacine,
Günzinger Ralf,
Deutsch MarcusAndré,
Badiu Catalin Constantin,
Krane Markus,
Lange Rüdiger
Publication year - 2014
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12232
Subject(s) - medicine , mitral valve replacement , endocarditis , surgery , aortic valve replacement , prosthesis , hemodialysis , infective endocarditis , valve replacement , retrospective cohort study , mitral valve , cardiology , stenosis
Abstract Background and Aim Third‐time valve surgery is rare and to date little is known about the surgical outcome. We reviewed our experience with third‐time aortic valve replacement (AVR) and third‐time mitral valve replacement (MVR) during an eight‐year period. Methods From 2001 to 2013, 32 patients were referred for third‐time AVR or third‐time MVR to our institution. In this retrospective analysis, patients were evaluated for postoperative morbidity including: hemodialysis, cerebrovascular event, pacemaker implantation, and 30‐day and mid‐term mortality. Results Third‐time replacement was for failed aortic valves in 20 (62.5%) patients and for failed mitral valves in 12 (37.5%) patients. Patients' mean age at the time of surgery was 56.3 ± 19 years. The mean interval between the first and the second procedure was 10 ± 7.8 years and between second and third replacement 7.3 ± 5.6 years. The failed prostheses included nine (28%) bioprostheses and 23 (72%) mechanical prostheses. The reasons for replacement were: infective valve endocarditis (31.3%), prosthesis dysfunction (37.3%), and paravalvular leakage (26%). The 30‐day mortality was 18.8% and during follow‐up was 31.3%. Hemodialysis was needed for eight patients (25.8%), pacemaker implantation for eight patients (25.8%), and cerebrovascular event occurred in four patients (13.3%). In patients with prosthetic valve endocarditis (n = 10), 30‐day and overall mortality were 11.1% and 30%, respectively. Conclusion Third‐time aortic or mitral valve replacement is a rare procedure but accompanied with high morbidity and mortality, especially in patients with prosthetic valve endocarditis. doi: 10.1111/jocs.12232 (J Card Surg 2014;29:8‐13)