Repeat aortic valve surgery: contemporary outcomes and risk stratification
| Autor: | Thierry Bové, Laurent De Backer, Yves Van Belleghem, Katrien François, Tine Philipsen, Thomas Martens |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Risk Assessment Cohort Studies 03 medical and health sciences Aortic aneurysm Postoperative Complications 0302 clinical medicine Aortic valve repair Valve replacement Aortic valve replacement Risk Factors Interquartile range Internal medicine Odds Ratio medicine Humans Aorta Aged Proportional Hazards Models Retrospective Studies Heart Valve Prosthesis Implantation Adult Cardiac Endocarditis business.industry Hazard ratio Aortic Valve Stenosis Odds ratio Middle Aged medicine.disease Aortic Aneurysm Treatment Outcome medicine.anatomical_structure 030228 respiratory system Aortic Valve Heart Valve Prosthesis Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interact Cardiovasc Thorac Surg |
| ISSN: | 1569-9285 |
| DOI: | 10.1093/icvts/ivaa257 |
| Popis: | OBJECTIVES Redo aortic valve surgery (rAVS) is performed with increasing frequency, but operative mortality is usually higher compared to that associated with primary aortic valve surgery. We analysed our patients who had rAVS to determine the current outcomes of rAVS as a surgical benchmark in view of the growing interest in transcatheter valve techniques. METHODS We retrospectively reviewed 148 consecutive patients [median age 67.7 years (interquartile range 54.9–77.6); 68.2% men] who underwent rAVS following aortic valve replacement (81.6%), aortic root replacement (15%) or aortic valve repair (3.4%) between 2000 and 2018. RESULTS Indications for rAVS were structural valve dysfunction (42.7%), endocarditis (37.8%), non-structural valve dysfunction (17.7%) and aortic aneurysm (2.1%). Valve replacement was performed in 69.7%, and 34 new root procedures were necessary in 23%. Early mortality was 9.5% (n = 14). Female gender [odds ratio (OR) 6.16], coronary disease (OR 4.26) and lower creatinine clearance (OR 0.95) were independent predictors of early mortality. Follow-up was 98.6% complete [median 5.9 (interquartile range 1.7–10.9) years]. Survival was 74.1 ± 3.7%, 57.9 ± 5.1% and 43.8 ± 6.1% at 5, 10 and 14 years, respectively. Cox regression analysis revealed female gender [hazard ratio (HR) 1.73], diabetes (HR 1.73), coronary disease (HR 1.62) and peripheral vascular disease (HR 1.98) as independent determinants of late survival. CONCLUSIONS Despite many urgent situations and advanced New York Heart Association functional class at presentation, rAVS could be performed with acceptable early and late outcomes. Risk factors for survival were female gender, coronary disease and urgency. In this all-comers patient cohort needing rAVS, only a minority would eventually qualify for transcatheter valve-in-valve procedures. |
| Databáze: | OpenAIRE |
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