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Updated: Aug 1, 2026
12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Re-operation for bioprosthetic aortic structural failure - risk assessment
W R E Jamieson1, L H Burr, R T Miyagishima
1331-332 Burrard Building, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. wrej@interchange.ubc.ca
Summary
Re-operation for bioprosthetic aortic valve failure has a lower mortality risk when performed in patients with lower New York Heart Association (NYHA) functional class. Early evaluation can lead to lower-risk reoperative surgery for structural valve deterioration.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Statistics
Background:
- Structural valve deterioration (SVD) is a primary complication of bioprosthetic valves, often necessitating re-operation.
- Prosthesis choice for aortic valve replacement (AVR) involves balancing risks of valve-related complications, including mortality and morbidity.
- Understanding mortality risks associated with bioprosthetic aortic valve failure is crucial for patient management.
Purpose of the Study:
- To determine the mortality rates associated with aortic bioprosthetic failure.
- To assess the risk factors contributing to mortality following re-operation for bioprosthetic aortic valve failure.
Main Methods:
- Analysis of 3530 aortic bioprosthetic implantations between 1975 and 1999.
- Review of 322 re-operations for structural valve deterioration, with assessment of concomitant procedures like coronary artery bypass (CAB).
- Evaluation of eleven predictive factors, including age, urgency status, and New York Heart Association (NYHA) functional class, using multivariate regression analysis.
Main Results:
- Overall re-operation mortality was 6.8% (22 fatalities).
- Mortality was significantly higher in patients with advanced NYHA functional class (IV: 16.0%) compared to lower classes (I/II: 2.0%).
- Multivariate analysis identified NYHA class III (OR 1.7) and IV (OR 7.8) as significant predictors of mortality. Gender was significant in the 1993-2000 period.
Conclusions:
- Re-operative mortality for bioprosthetic aortic valves can be reduced by performing surgery in patients with lower NYHA functional class.
- Routine patient evaluation facilitates earlier detection and intervention, leading to lower-risk reoperative procedures.
- Timely intervention in lower NYHA classes improves outcomes for patients with bioprosthetic aortic valve failure.
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