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The Annals of Thoracic Surgery, Vol 56, 15-20, Copyright © 1993 by The Society of Thoracic Surgeons
LH Cohn, SF Aranki, RJ Rizzo, DH Adams, KA Cogswell, NM Kinchla, GS Couper and JJ Collins Jr
We analyzed the risk of valve re-replacement in 640 patients reoperated on
between 1980 and 1992. This represented 17% of total valve operations
(640/3,764) during that period. A univariate and logistic multivariate
analysis was carried out for four sequential periods for the 640
re-replacement patients to determine if changing methods of perfusion and
myocardial protection affected recent results. There were 323 female and
317 male patients with a mean age of 58 years (range, 17 to 84 years).
Ninety-seven (15%) had coronary artery bypass grafting, 135 (21%) were 70
years old or older, 377 (59%) were in New York Heart Association functional
class III or less, and 263 (41%) were in functional class IV. The aortic
valve was re-replaced in 245, the mitral valve in 289, and both aortic and
mitral synchronously in 106. Four periods were analyzed: 1980 through 1982,
1983 through 1985, 1986 through 1988, and 1989 through 1992. The overall
operative mortality was 65 of 640 patients (10%), falling from 12/73 (16%)
in 1980 through 1982 to 23/268 (8%) in 1989 through 1992 (p = 0.05).
Univariate and multivariate logistic analysis documented that New York
Heart Association functional class was highly significant for operative
mortality; operative mortality was 4% for functional classes I through III,
and 19% for functional class IV (p < or = 0.001). The requirement for
coronary bypass was of borderline significance (p = 0.05), and year of
operation was also significant. Mortality for re-replacement of aortic
valve fell from 15% to 10%, double valve from 20% to 9%, and mitral valve
from 16% to 6%.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Decrease in operative risk of reoperative valve surgery
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
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