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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Risk of reoperation for aortic bioprosthesis dysfunction
Nicolas Jaussaud1, Vlad Gariboldi, Roch Giorgi
1Department of Cardiac Surgery, Timone University Hospital, Marseille, France. nicolas.jaussaud@ap-hm.fr
The Journal of Heart Valve Disease
|June 30, 2009
Summary
Reoperative aortic bioprosthesis replacement has a low operative mortality risk, suggesting the EuroSCORE may overestimate it. Patients can opt for bioprosthetic valves to avoid anticoagulation, even if future reoperation is likely.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Surgery
Background:
- Aortic bioprosthetic valve degeneration is a common cause for reoperation.
- The perceived risk of reoperative valve replacement influences initial prosthesis selection, particularly in younger patients (<70 years).
- Accurate risk assessment is crucial for surgical decision-making in aortic valve disease.
Purpose of the Study:
- To analyze the current mortality and morbidity associated with reoperative aortic bioprosthesis replacement.
- To identify preoperative risk factors for adverse outcomes in patients undergoing aortic bioprosthesis reoperation.
- To evaluate the predictive accuracy of the EuroSCORE for reoperative aortic bioprosthesis procedures.
Main Methods:
- Retrospective review of 156 patients undergoing reoperation for failed aortic bioprosthesis between 1990 and 2006.
- Analysis of causes for reoperation, including bioprosthesis degeneration, endocarditis, and paravalvular leak.
- Evaluation of operative mortality, postoperative morbidity, and associated procedures, alongside EuroSCORE calculations.
Main Results:
- Overall operative mortality was low at 3.8%.
- Emergency surgery was the only significant multivariable predictor of mortality (OR = 15.22, p = 0.02).
- Postoperative morbidity was low, and associated procedures did not significantly increase mortality risk.
Conclusions:
- Reoperation for aortic bioprosthesis dysfunction can be performed with a low mortality risk.
- The EuroSCORE appears to overestimate the risk associated with reoperative aortic bioprosthesis replacement.
- Bioprosthetic valves are a viable option for patients desiring to avoid long-term anticoagulation, even with anticipated reoperation.
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