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Repeat heart valve surgery: risk factors for operative mortality
J M Jones1, H O'kane, D J Gladstone
1Department of Cardiac Surgery, Queen's University, Royal Victoria Hospital, Belfast, Northern Ireland. jmj12@hotmail.com
The Journal of Thoracic and Cardiovascular Surgery
|November 2, 2001
Summary
First-time heart valve reoperations had an 8.6% operative mortality, decreasing over time. Certain factors like prosthetic valve dysfunction, endocarditis, and mechanical valve replacement significantly increased patient risk.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Valve Repair and Replacement
Background:
- Patients undergoing repeat heart valve operations represent a heterogeneous group.
- Assessing risk factors for operative mortality in first-time heart valve reoperations is crucial.
Purpose of the Study:
- To evaluate risk factors associated with operative mortality in patients undergoing their first heart valve reoperation.
Main Methods:
- Retrospective review of 671 hospital records for patients undergoing first repeat heart valve operations (1969-1998).
- Application of univariable and multivariable analyses to identify significant risk factors.
Main Results:
- Overall operative mortality was 8.6%, with a significant decrease over three decades.
- Higher mortality was observed for prosthetic valve dysfunction (10.6%), endocarditis (29.4%), and tricuspid valve replacement (25.6%).
- Replacement of mechanical valves (26.1%) carried higher mortality than tissue valves (8.6%).
- Multivariable analysis identified year, age, coronary artery bypass grafting, indication, and mechanical vs. tissue valve replacement as significant predictors of mortality.
Conclusions:
- Heart valve reoperations can be performed with acceptable operative mortality.
- Specific patient subgroups and indications are associated with increased risk during reoperation.