Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

Area of Science:

• Cardiovascular Surgery
• Medical Device Research

Background:

• Redo surgeries for bioprosthetic valve replacement are increasing due to higher implantation rates.
• Evaluating outcomes of redo aortic and/or mitral bioprosthesis replacement is essential.

Purpose of the Study:

• To assess intra-hospital mortality and morbidity in patients undergoing redo aortic and/or mitral bioprosthesis replacement.
• To identify predictors of mortality in redo cardiac surgery.

Main Methods:

• Retrospective study of 180 patients from 2005-2018 undergoing redo bioprosthetic valve replacement.
• Univariate analysis and propensity score adjustment to evaluate outcomes and risk factors.
• Comparison between aortic bioprosthesis replacement (Group A) and mitral bioprosthesis replacement (Group B).

Main Results:

• Overall intra-hospital mortality was 8.89%.
• Redo mitral bioprosthesis replacement (Group B) was associated with increased risk of death (OR 3.32), gastrointestinal complications (OR 7.784), and pulmonary complications (OR 2.381) after adjustment.
• Endocarditis, longer cardiopulmonary bypass and aortic cross-clamping times, higher NYHA class, and urgent setting predicted mortality.

Conclusions:

• Intra-hospital outcomes for redo bioprosthetic valve surgery were acceptable.
• Patients undergoing redo mitral bioprosthesis surgery face significantly higher risks of mortality and specific complications.
• Careful consideration of mitral bioprosthesis choice during the initial surgery is recommended.