[Operation methods and results in repeated open heart surgery for acquired valvular disease]

Fifty-six patients who underwent repeated open heart surgery for acquired valvular disease are presented. Their mean ages were 48 years and mean interval between initial and second operation were 6 years. Preoperative functional status (NYHA) were class II in 11, class III in 40 and class IV in 5. The indications for repeated open heart surgery were mitral re-stenosis in eight, mitral and aortic regurgitation after valvuloplasty in 26, artificial valve failure in 32, perivalvular leakage in 2, left atrial thrombus formation in 1 and aggravation of rheumatic changes of non-operated other valves in 3. Dissection of adhesive tissue around the heart was limited to the aortic root for prevention of cardiac injuries and minimizing bleeding. In all cases, myocardial protection was achieved with intermittent infusion of cold crystalloid cardioplegic solution with topical myocardial cooling during single period of aortic clamping. Adequate left ventricular hypothermic protection was obtained by cold physiological saline that was filled in left pleural cavity. Postoperative low cardiac output syndrome was developed in only 2. Three patients (5.4%) died of left ventricular rupture and of multiple organ failure within thirty days and 4 patients (7.1%) died of prosthetic valve endocarditis, cerebral bleeding and sudden death in late follow-up periods. These results suggested that the operative mortality and morbidity for repeated valve surgery with the aid of cardiopulmonary bypass was not different from that for initial valve surgery. So we believe that repeated open heart surgery for acquired valvular disease should be done prior to deterioration of patient's clinical condition.