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

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Abstract
During the 1970s, initial clinical experience with bioprosthesesdetermined their worldwide use. However, bioprosthetic reoperation (BPR) isnow common, particularly in groups with extensive implantation of thesevalve substitutes. From January 1980 to December 1989, a total of 470patients had a total of 618 reoperations for bioprosthetic dysfunction andwere retrospectively analyzed. Eighty-seven patients required a second BPR,21 a third BPR, 5 a fourth BPR and 1 patient a fifth BPR. Structuraldeterioration was the main cause of valve dysfunction for the first andsecond BPR. However, paravalvular leak and infective endocarditis were morefrequent for the remaining additional reoperations. Hospital mortality was12.6%, 14.9% and 37% after the first, second and third or subsequent BPR,respectively. Univariate statistical analysis shows as hospital mortalityrisk factors: age at the time of the surgery, preoperative NYHA functionalclass IV, emergency surgery, concomitant tricuspid surgery, double(mitro-aortic) valve dysfunction, active infective endocarditis as thecause of failure and prolonged aortic cross-clamping time. Hospitalmortality declined from 19.8% to 11.8% for the first and second halfdecade, respectively (P less than 0.005). In conclusion, bioprostheticvalve reoperation entailed a higher hospital mortality, particularly in therisk group of patients. In our hands, surgical experience has determinedthe improvement of the clinical results in this group of patients.

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