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[Repeated valvular replacements]
Insights
Repeated cardiac valve replacement surgery, even third or fourth replacements, is becoming more common. This study found that despite increased complexity, repeated valve replacement carries an acceptable operative risk for patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Medical Device Technology
Context:
- Increasing frequency of repeat cardiac valve replacement surgeries.
- Over two decades of data collection (1970-1984) at Hôpital Foch.
- Analysis of 2072 implanted prostheses, with 6.4% requiring at least one reoperation.
Purpose:
- To evaluate the outcomes and risks associated with multiple cardiac valve reoperations.
- To assess the technical feasibility and patient survival after repeated valve replacements.
- To determine the long-term functional status of patients undergoing multiple valve surgeries.
Summary:
- 134 out of 2072 valve prostheses required reoperation; 27 (1.3%) underwent three or more replacements in 23 patients.
- Procedures, primarily median sternotomy, involved simple valve replacement or more complex techniques.
- Hospital mortality was 13%, with 10% late deaths; 17 survivors showed improved NYHA functional class.
Impact:
- Repeated valve replacement demonstrates an acceptable operative risk.
- Suggests feasibility of complex cardiac valve reoperations.
- Highlights the need for careful patient selection and surgical planning for multiple valve replacements.
Abstract:
After more than two decades of cardiac valve replacement surgery, the number of reoperations has increased and third or even fourth replacements are no longer rare occurrences. Of the 2072 valves prostheses implanted at the Hôpital Foch between 1970 and December 1984, 134 (6.4%) have been changed at least once and 27 prostheses (1.3%) have been replaced three or more times in 23 patients. Eighteen patients were operated on three times and 5 patients 4 times, a total of 73 operations. Ten patients had aortic valve prostheses, 7 had mitral valve prostheses and 6 had double aortic and mitral valve prostheses. The technical difficulties due to previous cardiac surgery were not great or easily surmounted as every procedure was performed by a median sternotomy and only 2 out of 50 required cannulation of the femoral vessels for cardiopulmonary bypass. The repair itself consisted of simple valve replacement in 3 out of 4 cases (30 single and 3 double valve replacements, 3 valve reinsertions). The other operations required more complex techniques such as remodelling of the ring of insertion or the use of a valved tube. None of the patients died in the operating theatre. However, 3 patients died during the hospital period (13%) and there were 2 late deaths (10%) and 1 patient (5%) was lost to follow-up. The 17 survivors were followed up for 3 to 148 months (average 42 months). Half the patients are now in functional Classes I or II of the NYHA classification. These results show that repeated valve replacement has an acceptable operative risk.(ABSTRACT TRUNCATED AT 250 WORDS)