Reoperation for Prosthetic Heart Valve Replacement

Summary

From 1974 to 1984, 847 heart valve replacement operations were performed with 1005 prosthetic valves. Thirty-nine (4.6 %) were reoperations with 43 prosthetic valve replacements (PVR), on 38 patients. Thirty-three patients had received their initial valve replacement in our hospital and 5 elsewhere. Twenty additional cardiac procedures were required, concomitantly with the prosthesis replacement. Twenty-three patients underwent replacement of a mechanical prosthesis (61 %) an average of 4.3 years after initial implantation and 15 patients a bioprosthesis (39 %) after 2.8 years. Indications for PVR were endocarditis in 15 patients (39 %), prosthesis failure in 13 (34%), periprosthetic leak in 7 (18 %), thrombosis in 2 (5 %), and a left ventricle subannular aneurysm in 1 (3 %). Preoperatively 4 patients were in NYHA functional class II (11 %), 15 in class III (39 %) and 19 in class IV (50 %). Six patients died eariy postoperatively (15.8 %) Various risk factors were analyzed. The early mortality rate was 22% for mechanical prosthesis replacement and 7% for bioprosthesis; 11 % for aortic position, 13 % for mitral position and 50 % to 100 % for double valve replacement; 23% for non-elective and 6 % for elective operations; 10 % for patients with only an initial valve replacement and 43 % with additional previous valve operations; 18 % for active endocarditis, 15% for prosthesis failure, 14% for periprosthetic leak, 0 % for thrombosis and 100 % for subannular aneurysm; 0 % for patients in class II, 7% in class III and 26% in class IV; 6% in patients with an aortic cross-clamp time less than 2 hours and 24% with more; 27 % prior to 1981 and 9% during the last 4 years; and finally 50 % in patients over the age of 60. There were 9 late deaths (23.6 %), 4 of the endocarditis group, 4 of the periprosthetic leak group and 1 of the prosthesis failure group. Eight occurred within 10 months: 4 from cardiac reasons, 2 from sepsis and 2 during a second PVR (one elsewhere). One patient died of cardiac causes after 4 years. From the 22 survivors followed up for an average of 33 months, 36 % was in class I, 45 % in class II, 14 % in class III and 5 % in class IV. The cumulative actuarial survival rate was 72 % at one year and 66% at 5 years after PVR.

Key words

Indications and risk factors - Prosthetic valve replacement - Early and late prognosis