Outcomes of patients undergoing third-time aortic or mitral valve replacement

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.

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.

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.

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.