[Reoperation for valvular heart disease: its operative procedure and result]

From April, 1983 to March, 1993, 63 patients (pts) underwent reoperations of valvular heart disease at Tokyo Medical and Dental University Hospital, of which 44 pts had undergone closed mitral commissurotomy (CMC), open aortic or mitral commissurotomy (OAC or OMC) or valvuloplasty, and 17 pts had undergone aortic or mitral valve replacement (AVR or MVR). Valve replacement was performed in 59 pts (mechanical valve replacement; 42 pts, porcine valve replacement; 12 pts), and 2 pts received OMC due to restenosis after CMC. Preoperative diagnosis included restenosis after CMC, OMC or valvuloplasty in 43 pts, bioprosthetic dysfunction after MVR in 10 pts, perivalvular leakage after AVR in 1 pt, valve detachment after AVR in 4 pts (Beçhet 3 pts, infective endocarditis 1 pts). Valve replacement or valvuloplasty was done for another valves in addition to the previously operated valve in 44 pts (72.1%), especially for tricuspid valve. Restenosis after CMC, occurred at 20.6 years after surgery, and restenosis after OMC and valvuloplasty at 13.1 years. Bioprosthetic dysfunction after MVR occurred at 8.5 years. Valve dysfunction of the mechanical valve was not observed. The early operative mortality after reoperations was 11.5% (7 pts) in this series. And 3 pts (4.9%) died in the late follow-up due to cancer in 1 pt and congestive heart failure in 2 pts. A first choice of mechanical valve for redo valve replacement for aortic/mitral valve, and modified AVR using composite graft and proximal double fixation to the fragile annulus seemed to be satisfactory to accomplish better operative results.