Not as Dangerous as Expected—Outcome of the Pure Aortic Valve Reoperation

Background: In the last decades bioprostheses are continuously outperforming mechanical heart valves. Therefore a large portion of patients will present with a degenerated bioprosthesis needing redo aortic valve replacement (rAVR). Present literature constantly mixes up different entities of primary surgeries, e.g., CABG or mitral, etc. … and partially including prosthetic valve endocarditis. Indeed only little is known about the pure rAVR after primary isolated AVR. The present study sought to evaluate this lack of knowledge.

Methods: Between 2009 and 2021 a total of 26,545 patients underwent cardiac surgery at our institution. Out of these, 68 patients (0.26%) met the inclusion criteria. Inclusion criteria were first surgery consisting of isolated AVR and actual surgery being isolated rAVR for non-infectious reasons in adult patients. The data were retrospectively collected out of the hospital’s database and a descriptive statistical data analysis performed using the open-source statistical software package R, version 4.4.1. The categorial variables were expressed as numbers and percentages, and continuous variables were expressed as medians.

Results: The mean EuroSCORE II (%) was 9.95 ± 10.10, indicating a high-risk subgroup. Main comorbidities consisted of chronic lung disease (n = 11/68; 16.2%), extracardiac arteropathy (n = 18/68; 26.5%) and severe pulmonary hypertension (n = 8/68; 11.8%). First surgery dated back 9.1 years with 83.8% (n = 57/68) of the patients presenting with a degenerated bioprosthesis and 16.2% (n = 11/68) with a failed mechanical valve. Actual skin-to-skin time was 145 minutes with 48 minutes x-clamp with no intraoperative deaths. Median amount postoperative drainage in the first 24 h was 600 mL. No patient needed re-exploration for bleeding. The 30-day mortality rate was 2.9% (n = 2/68). Main postoperative morbidity consisted of need for permanent pacemaker (n = 16/68; 26.5%), stroke in 2.9% (n = 2/68) and temporary renal replacement therapy in 5.9% (n = 4/68). Beside this, the postoperative course was uneventful. The median length of hospital stay was 13 days, of which ICU stay accounted for 2 days.

Conclusion: Postoperative mortality and morbidity mainly referred to patient’s comorbidities. Surgery itself is not the limiting factor and can be done with the same quality as the primary procedure. Generally, the observed clinical mortality of the pure aortic valve exchange was far lower than predicted.

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Artikel online veröffentlicht:
11. Februar 2025