Redo Aortic Valve Surgery: Early and Late Outcomes

Leontyev, Sergey; Borger, Michael A.; Davierwala, Piroze; Walther, Thomas; Lehmann, Sven; Kempfert, Jörg; Mohr, Friedrich W.

doi:10.1016/j.athoracsur.2010.12.053

Cited by 144 publications

(107 citation statements)

References 23 publications

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“…Our study confirms the results from previous publications on isolated re-AVR in which early mortality and decreased long-term survival have been associated with low LVEF and NYHA III/IV (8)(9)(10)(11)(12). The steep operative mortality in the LEF group (13.5%) was considerably higher compared to the published mortality of non-reoperative (first time) cardiac surgery patients with low LVEF (5.6% to 11%) (13)(14)(15) and to the previously published operative mortality in all re-AVR patients (4.5% to 5.1%) (8,9), to which the 3.2% mortality of our re-AVR HEF group compares favorably.…”

Section: Discussionsupporting

confidence: 92%

“…The steep operative mortality in the LEF group (13.5%) was considerably higher compared to the published mortality of non-reoperative (first time) cardiac surgery patients with low LVEF (5.6% to 11%) (13)(14)(15) and to the previously published operative mortality in all re-AVR patients (4.5% to 5.1%) (8,9), to which the 3.2% mortality of our re-AVR HEF group compares favorably. The contrasting outcomes of re-AVR LEF patients to both HEF and historic groups stress the increased risk conferred by the presence of low ventricular contractility and a prior sternotomy.…”

Section: Discussioncontrasting

confidence: 56%

“…Low preoperative LVEF is independently associated with worse outcomes after AVR and is a proxy for the patient's underlying ventricular contractility, an important component in low-gradient aortic stenosis (8,9). In the STS-CSRM, every 10 unit decrease in LVEF is associated with 1.09 times the odds of operative mortality (OR: 1.09, 95% CI: 1.05-1.14) (4).…”

Section: Surgeons Predictive Risk Of Mortality (Sts-prom)mentioning

confidence: 99%

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Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Yammine

Val

Ejiofor

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Patient comorbidities play a pivotal role in the surgical outcomes of reoperative aortic valve replacement (re-AVR). Low left ventricular ejection fraction (LVEF) and renal insufficiency (Cr >2 mg/dL) are known independent surgical risk factors. Improved preoperative risk assessment can help determine the best therapeutic approach. We hypothesize that re-AVR patients with low LVEF and concomitant renal insufficiency have a prohibitive surgical risk and may benefit from transcatheter AVR (TAVR).Methods: From January 2002 to March 2013, we reviewed 232 patients who underwent isolated re-AVR.Patients older than 80 years were excluded to adjust for unobserved frailty. We identified 37 patients with a ≤35% LVEF (low ejection fraction group-LEF) and 195 patients with >35% LVEF (High ejection fraction group-HEF).Results: The mean age was 68.4±11.5 years and there were more females (86.5% versus 64.1%, P=0.007) in the LEF group. The prevalence of renal insufficiency was higher in LEF patients (27% versus 5.6%, P=0.001).Higher operative mortality (13.5% versus 3.1%, P=0.018) was observed in the LEF group. Stroke rates were similar in both groups (8.1% versus 4.1%, P=0.39). Unadjusted cumulative survival was significantly lower in LEF patients (6.6 years, 95% CI: 5.2-8.0, versus 9.7 years, 95% CI: 8.9-10.4, P=0.024). In patients without renal insufficiency, LEF and HEF had similar survival (8.3 years, 95% CI: 7.1-9.5, versus 9.9 years, 95% CI:9.1-10.6, P=0.90). Contrarily, in patients with renal insufficiency, LEF led to a significantly lower survival (1.1 years, 95% CI: 0.1-2.0, versus 4.8 years, 95% CI: 2.2-7.3, P=0.050). Adjusted survival analysis revealed elevations in baseline creatinine (HR =4.28, P<0.001) and LEF (HR =5.33, P=0.041) as significant predictors of long-term survival, with a significant interaction between these comorbidities (HR =7.28, P<0.001). Conclusions:In re-AVR patients, low LVEF (≤35%) is associated with increased operative mortality.Concomitant renal insufficiency in these patients results in a prohibitively low cumulative survival. These reoperative surgical outcomes should warrant expanding the role of TAVR for reoperative patients with LEF and renal impairment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 56%

Section: Surgeons Predictive Risk Of Mortality (Sts-prom)mentioning

confidence: 99%

See 1 more Smart Citation

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Yammine

Val

Ejiofor

et al. 2017

Ann. Cardiothorac. Surg.

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“…When considering surgical procedures, the repair of periprosthetic valve leaks carries the highest risk, while conservative mitral valve surgery carries the lowest. [2,[9][10][11][12] Meanwhile, in our study the presence of emergency surgery, infective endocarditis, stuck valve, and infection were associated with early period mortality. On the other hand, gender, age, valve type used in the first operation, multiple valve surgery, and increased pulmonary artery pressure were unrelated.…”

Section: Discussionmentioning

confidence: 87%

“…[ [11][12][13] We also determined that left lateral chest X-rays provided sufficient preoperative assessment during a 15-year period when CT was not widely used.…”

Section: Discussionmentioning

confidence: 99%

Repeat valve surgery: An analysis of 182 patients

Özyazicioğlu¹

2012

Turk Gogus Kalp Dama

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Background: In this study, we aimed to investigate the preoperative and operative risk factors in patients undergoing valve replacement for the second time, including the types of valves and surgical methods used. Methods: Between January 1994 and December 2009, a total of 2089 valve replacements were performed in our clinic, and 182 (112 females, 70 males) of these operations (8.7%) were repeat valve surgeries. Results: The mean age for repeat surgery was 49.2±27.4 years while the mean time elapsed between the first and second surgeries was 11.8±5.7 years. The follow-up period after repeat surgery was 2.6±1.3 years. Bioprosthesis valves were removed from a total of 142 patients (78%), and mechanical valves were removed from 40 patients (22%). In total, 221 valves were replaced. The total number of valves implanted was 219, and valve repair alone was performed on three patients. Of the valves implanted in repeat surgery, 197 (90%) were mechanical valves. The preoperative echocardiography findings revealed that the major problem (84%) observed was valve dysfunction, followed by infection. Fifteen patients (8.2%) who underwent repeat surgery died during the operation or within the first month afterwards. Conclusion:Repeat heart valve surgery may be performed using the standard surgical procedures with acceptable mortality. Factors increasing the probability of repeat surgery include emergency interventions and infections; however, pulmonary hypertension is not a factor that increases the probability of repeat valve replacement surgery.

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Transseptal strategy in retrograde transcatheter valve‐in‐valve implantation for failed surgical aortic bioprosthesis

Lam

Bertog

Sievert

2014

Cathet Cardio Intervent

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We report a challenging case of transcatheter aortic valve-in-valve implantation in an elderly patient with failed surgical bioprosthesis. The transthoracic echocardiogram demonstrated a severe stenosis with a peak gradient of 142 mm Hg. The patient was a high-risk candidate for reoperative valve replacement; therefore, transfemoral implantation of a CoreValve (Medtronic Inc, Minneapolis, MN) was decided. During the procedure, we were unable to introduce the delivery catheter system across the bioprosthesis due to its poor alignment with the aortic annulus and the severity of the stenosis. With strategies involving transseptal puncture and externalization of a guidewire in an antegrade manner, the CoreValve was successfully positioned and deployed. This case illustrated the utility of transseptal strategies in challenging retrograde transcatheter aortic valve-in-valve implantation.

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Redo Aortic Valve Surgery: Early and Late Outcomes

Cited by 144 publications

References 23 publications

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Repeat valve surgery: An analysis of 182 patients

Transseptal strategy in retrograde transcatheter valve‐in‐valve implantation for failed surgical aortic bioprosthesis

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