Multiple reoperations on the aortic valve: outcomes and implications for future potential valve-in-valve strategy†

Abstract

Multiple AV reoperations carry an acceptable risk of early postoperative mortality, particularly for isolated valve replacements of SVD.

Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

“…Our mortality was in line with already published data, being between 7.3% and 10.9% [ 15 , 16 , 17 , 18 , 19 ]. Among predictors of mortality, our univariate analysis found that CPB time, aortic cross-clamping time, NYHA ≥ 3, urgency setting and endocarditis were significant predictive factors.…”

“…Of interest, replacement of mitral bioprosthesis was a risk factor for death, gastrointestinal and pulmonary complications. A similar result was reported by Jones et al and Lytle et al [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ], whose studies demonstrated that patients undergoing mitral valve replacement have a higher risk of mortality than patients undergoing aortic valve replacement, mainly due to post-operative acute myocardial infarction, rupture of the left ventricle and arrhythmias. Nevertheless, the causes of death in our patients in group B were multi-organ failure and cardiogenic shock.…”

Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysis

“…Postoperative early and late transition probabilities specific to mAVR ( Table E1 ) and the Ross procedure ( Table E2 ) were derived from published reports. 2 , 3 , 5 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 These transition probabilities reflected risks of developing various procedure-specific complications and reinterventions, in addition to the mortality associated with these adverse events.…”

“…This is also a single center's experience, making it less generalizable to other centers with lower-volume or different care team. Joshi et al E4 Description This is a single-center retrospective cohort study (2007-2016) that investigates the morbidity and mortality for patients (n = 316) who have had a 1 (n = 263), 2 (n = 42), and 3 (n = 11) redo AVRs. Strengths/applicability This is a large study that provides probabilities regarding the morbidity and mortality after a redo AVR; these are probabilities that are infrequently reported and difficult to find in published reports.…”

“…Long-term mortality = 1 − (Freedom from all-cause mortality at 10 y)/(10 y) = 13%/[10 y (follow-up time)] = 0.0130 Large sample size (405) Maximum 1.85%/y Myers et al E2 Figure 1. Long-term mortality = 1 − (Freedom from all-cause mortality at 10 y)/(10 y) = 18.5%/[10 y (follow-up time)] = 0.0185 Death after reintervention Valve failure Baseline 7.30% Joshi et al E4 Text—Results, Immediate Postoperative Outcomes: “Overall hospital mortality was 7.3%” = 0.0730 This was the only acute reintervention probability identified from the literature representative of this paradigm. Values in superscripts correspond to reference numbers from which the data were obtained.…”