Reoperation for bioprosthetic valve dysfunction *1A decade of clinical experience

Abstract

During the 1970s, initial clinical experience with bioprostheses determined their worldwide use. However, bioprosthetic reoperation (BPR) is now common, particularly in groups with extensive implantation of these valve substitutes. From January 1980 to December 1989, a total of 470 patients had a total of 618 reoperations for bioprosthetic dysfunction and were retrospectively analyzed. Eighty-seven patients required a second BPR, 21 a third BPR, 5 a fourth BPR and 1 patient a fifth BPR. Structural deterioration was the main cause of valve dysfunction for the first and second BPR. However, paravalvular leak and infective endocarditis were more frequent for the remaining additional reoperations. Hospital mortality was 12.6%, 14.9% and 37% after the first, second and third or subsequent BPR, respectively. Univariate statistical analysis shows as hospital mortality risk factors: age at the time of the surgery, preoperative NYHA functional class IV, emergency surgery, concomitant tricuspid surgery, double (mitro-aortic) valve dysfunction, active infective endocarditis as the cause of failure and prolonged aortic cross-clamping time. Hospital mortality declined from 19.8% to 11.8% for the first and second half decade, respectively (P less than 0.005). In conclusion, bioprosthetic valve reoperation entailed a higher hospital mortality, particularly in the risk group of patients. In our hands, surgical experience has determined the improvement of the clinical results in this group of patients.

The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement: an observational study

“…For the first and second reoperations valve dysfunction was the main reported cause however, PVL and infective endocarditis were more frequent for the remaining additional reoperations (8,9). The independent predictors of mortality in patients who underwent valvular reoperations for prosthetic valve dysfunction has been reported as; 1-advanced NYHA (New York Heart Association) functional class and 2-higher serum creatinine levels.…”

“…Surgical reoperation is the gold standard of therapy for PVL but is associated with high perioperative mortality risk (1,6,8).…”

Percutaneous Closure of 2 Paravalvular Leaks and a Gerbode Defect after Mitral Valve Replacement for Infective Endocarditis

“…3 Surgical repair is recommended for PVL, but reoperation is associated with a mortality rate of approximately 16%, which rises upon further surgical attempts. 4 In 1992, Hourihan and associates 5 reported the first transcatheter percutaneous closures in patients with aortic PVL; since then, this approach has often been a viable alternative for high-risk patients with this sequela. Although reported success rates for percutaneous closure range from 60% to 90%, up to 40% of patients with PVL might need reintervention.…”

Percutaneous Paravalvular Leak Closure

“…Re-do surgery carries a high recurrence rate, as well as greater risks of morbidity and mortality than the initial procedure. 8 Percutaneous approaches to PVL closure have therefore been developed as a less-invasive strategy, and may be accomplished via transseptal (TS) access, apical left ventricular (LV) access, or retrograde arterial access. 9 Since the first reports of the procedure in 1992, a number of series have been published, with encouraging rates of procedural success and good clinical outcomes.…”