Reoperations on Heart Valve Prostheses

Kim, Jae Hyun; Choi, Sae Young; Yoo, Young Sun; Lee, Kwang Sook; Yoon, Gyung Chan; Park, Chang Kwon

Abstract

BACKGROUND: All currently available mechanical and bioprosthetic valves are associated with various types of deterioration leading to dysfunction and/or valvular complications. Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. This review was conducted to determine the factors affecting the risk of reoperation for prosthetic valve replacement. MATERIAL AND METHOD: From January 1985 to July 1996, 124 patients underwent reoperation on prosthetic heart valves, and 3 patients had a second valve reoperation. The causes of reoperation were prosthetic valve failure (96 cases, 77.4%), prosthetic valve thrombosis (16 cases, 12.9%), prosthetic valve endocarditis (7 cases, 5.6%) and paravalvular leak (5 cases, 4.1%). This article is based on the analysis of the experience with particular emphasis on the preoperative risks affecting the outcome of the reoperation. RESULT: Overall hospital mortality rate was 8.9% (11/124). Low cardiac output was the most common cause of death (70.6%). Left ventricular systolic dimension (p=0.001), New York Heart Association functional class IV (p=0.003) and serum creatinine level (p=0.007) were the independent risk factors, but age, sex and cardiothoracic ratio did not have any influence on the operative mortality. Follow-up period was ranged from 3 to 141 months (mean, 50.6 months). A late mortality rate was 1.8%.
CONCLUSION
The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, therefore reoperation is recommended before the hemodynamic impairment become severe.