Summary
Reoperations after cardiac valve replacement are unavoidable: their frequency depends
on surgical technique, type of valve used, and the anatomical situation. Erlangen,
almost 300 such procedures were required among 3500 valve replacements, while 19 out
of 700 bioprostheses had to be exchanged. Statistically relevant complications occurring
with variable frequency are paravalvular leakage, thrombosis and degeneration of the
bioprostheses which have to be corrected for hemodynamic reasons. Other indications
are thromboembolism and endocarditis.
Rare complications are: rupture of the posterior wall of the ventricle or aortic root
with subsequent development of aneurysm, entrapment of the occluder due to long sutures,
pannus, muscle chordae, strut fracture (Björk) or wear of the occluder (Wada, Starr,
Edwards, Beall).
Some complications as dehiscence, entrapment, rupture and aneurysm of the posterior
wall of the ventricle and aortic root can largely be avoided by good surgical techniques.
Reoperative mortality rate is slightly higher due to greater possibilities of injury
and bleeding. Emergency procedures in grade IV NYHA have the highest rate (50 %),
elective procedures for leakage, calcified or regurgitant bioprostheses the lowest.
The most frequent indication for re-operation is perivalvular leakage. Dehiscence
requires surgery to deal with hemolysis or for hemodynamic reasons. Dehiscence is
more common in aortic than in mitral position; the latter can be closed by felt-padded
stitches in 80 %. This technique is the most reliable in preventing leakage, although
thrombosis is more likely. Causes of dehiscence are endocarditis, sutureline tearing,
calcium in the annulus. The incidence of valve thrombosis is related to valve type,
usually associated with inadequate or. abruptly terminated anticoagulation therapy
(rebound). Disc valve are at particular risk.
Thromboembolism occurs in 3 to 5 % per patient year. Anticoagulation therapy represents
optimal prophylaxis. Recurrent thromboembolism despite optimal anticoagulation requires
valve replacement.
Key words
Complications after valve replacement - Mortality after reoperation
