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The Annals of Thoracic Surgery, Vol 42, 632-643, Copyright © 1986 by The Society of Thoracic Surgeons
BW Lytle, DM Cosgrove, PC Taylor, CC Gill, M Goormastic, LR Golding, RW Stewart and FD Loop
One thousand consecutive cardiac reoperations for valve surgery in 897
patients were reviewed to determine in-hospital mortality and indicators of
risk. Subgroups based on the number of previous cardiac procedures and the
valve or valves replaced or repaired at reoperation (aortic valve, mitral
valve, tricuspid valve, or multiple valves and mortality [deaths/number of
procedures (% mortality)]) for those subgroups are as follows: (Table: see
text) Predictors of increased risk for a first aortic valve reoperation
were advanced age (p = .0002), endocarditis (p = .0018), female sex (p =
.014), impaired left ventricular function (p = .039), and number of
coronary vessels obstructed by 70% or more (p = .055). For a first mitral
valve reoperation, the predictors were advanced age (p less than .0001),
preoperative shock or cardiac arrest (p = .01), previous aortic or
tricuspid valve operations (p = .02), type of mitral valve procedure (risk
for repair of periprosthetic leak was greater than mitral valve replacement
which was greater than mitral valve-conserving operation [p = .05]), and
impaired left ventricular function (p = .059). For a first multiple valve
reoperation, the predictors were diabetes (p = .04) and ascites (p = .02),
whereas patients undergoing mitral valve replacement and tricuspid valve
operations were at decreased risk (p = .01). Comparison of second
reoperations with first reoperations indicates risk increases for multiple
operations (p = .01) but not for aortic or mitral valve procedures.
Rereplacement of a prosthesis (p = .007), coronary bypass grafting at
reoperation (p = .006), and advanced age (p = .06) increased the risk for
second reoperations. Age is the most consistent predictor of risk for
patients undergoing valve reoperations.
ARTICLES
Reoperations for valve surgery: perioperative mortality and determinants of risk for 1,000 patients, 1958-1984
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