Reoperations on prosthetic heart valves: an analysis of outcome

To evaluate risks and complications of reoperations on prosthetic heart valves, we reviewed data on 70 patients who underwent reoperations because of prosthetic valve malfunction. Overall hospital mortality was 13% (9/70 patients). The common cause of death was low cardiac output syndrome following surgery (4 patients). Respiratory failure and mediastinal infection accounted for 2 deaths each, and neurological complication for 1 death. However, hospital mortality was different according to the risk factors; reoperations for prosthetic valve endocarditis (18%, p < 0.05), advanced New York Heart Association (NYHA) class (50%, p < 0.001), and emergency operation (33%, p < 0.005) were the significant risk factors. In contrast, advanced age, female sex, type of prosthesis, valve position, and diagnosis (leak, structural deterioration, or valve thrombosis) did not appear to be significant risk factors. There were 7 late deaths (4 valve-related, 2 cardiac, and 1 noncardiac). Inasmuch as emergency operation, advanced NYHA class, and prosthetic valve endocarditis affected hospital mortality, these factors contributed to late death. Actuarial survival rate and freedom from valve-related mortality at 10 years were 75.8 +/- 2.8% and 87.2 +/- 2.3%, respectively. There were 8 valve-related complications, and freedom from valve-related complications at 10 years was 73.5 +/- 3.5%. As judged by these data, hospital mortality and late survival can be improved if hemodynamic conditions leading to myocardial damage can be prevented.