Clinical Analysis of Repeated Heart Valve Surgery in 325 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Chong , HAN Lin , LU Fanglin , XU Jibin , ZOU Liangjian , XU Zhiyun .

Department of Cardiothoracic Surgery， Changhai Hospital， Second Military Medical 　University， Shanghai 200433， P. R. China;

Corresponding author：

Keywords：

Heart valve; 　Reoperation; 　Perioperative death; 　Risk factor

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Abstract： Objective To summarize surgical experiences and explore risk factors of patients undergoing repeated heart valve surgery. Methods Clinical records of 325 consecutive patients who underwent repeated heart valve surgery from January 1998 to December 2008 in Changhai Hospital of Second Military Medical University were retrospectively　 analyzed. There were 149 male patients and 176 female patients with their average age of （47.1±11.8） years. Following　 variables were collected: preoperative morbidity， heart function， indications and surgical strategies of repeated heart valve surgery， postoperative mortality and morbidity， which were compared with those clinical data of patients who underwent their first heart valve surgery during the same period. Multivariate logistic regression was used to determine risk factors of perioperative death of patients undergoing repeated heart valve surgery. Results The main reasons for repeated heart valve surgery were mitral valve restenosis after closed mitral commissurotomy and new other valvular diseases. Postoperatively， 28 patients died in the early-stage with the overall mortality of 8.6% （28/325）. The main reasons of in-hospital death included low cardiac output syndrome （LCOS）and acute renal failure. Compared with patients undergoing their first heart valve surgery， patients who underwent repeated heart valve surgery were more likely to have chronic obstructive　 pulmonary disease （COPD)， New York Heart Association (NYHA） classⅢ-Ⅳ， and atrial fibrillation， preoperatively. Their cardiopulmonary bypass time and aortic cross clamp time were comparatively longer. They also had more postoperative　 morbidities such as LCOS， acute renal failure and acute respiratory distress syndrome （ARDS）. Multivariate logistic regression showed that preoperative critical state （OR=2.82， P=0.002）， cardiopulmonary bypass time longer than 120 minutes （OR=1.13， P=0.008）， concomitant coronary artery bypass grafting （OR=1.64， P=0.005）， postoperative LCOS（OR=4.52， P＜0.001）， ARDS （OR=3.11， P＜0.001） and acute renal failure （OR=4.13， P＜0.001）were independent risk factors of perioperative death of patients undergoing repeated heart valve surgery. Conclusion Repeated heart valve surgery is a difficult surgical procedure with comparatively higher risks. Full preoperative assessment of the valvular lesions，　 proper timing for surgery and perioperative management are helpful to reduce postoperative mortality and morbidity.

Citation： WANG Chong,HAN Lin,LU Fanglin,XU Jibin,ZOU Liangjian,XU Zhiyun .. Clinical Analysis of Repeated Heart Valve Surgery in 325 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 24-28. doi: Copy

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13.	Toker ME， Kirali K， Balkanay M， et al. Operative mortality after valvular reoperations. Heart Surg Forum， 2005，8 （4）： E280-E283.
14.	Oz BS， Iyem H， Akay HT， et al. Risk factors for short- and long-term survival in patients undergoing re-replacement due to prosthetic valve dysfunction. Heart Vessels， 2006， 21 （6）：339-343.
15.	Beurtheret S， Gariboldi V， Feier H， et al. Short-term results of　 repeat valve replacement：a predictive factor analysis. J Heart Valve Dis， 2010， 19 （3）：326-332.
16.	[2012-03-21]. http：//www. scts. org.

1. 　Keogh B， Kinsman R. Fifth national adult cardiac surgical database report. Society of Cardiothoracic Surgeons of Great Britain and Ireland；.
2. 　Rabkin E， Schoen FJ. Cardiovascular tissue engineering. Cardiovasc　 Pathol， 2002，11 （6）：305-317.
3. 　邹良建，张宝仁，徐志云，等. 再次与多次心脏瓣膜置换术132 例. 中华胸心血管外科杂志， 2003， 19 （3）：173 - 174.
4. 　刘永民，胡盛寿，吴信. 人工心脏瓣膜再次或多次置换术333 例分析. 中华胸心血管外科杂志， 2002， 18 （1）：42 - 43.
5. 　Jones MJ， O’Kane H， Gladstone DJ， et al. Repeat heart valve　 surgery： risk factors for operative mortality. J Thorac Cardiovasc Surg，2001，122 （5）：913-918.
6. 　de Brandão CM， Pomerantzeff MA， Souza LR， et al. Multivariate analysis of risk factors for hospital mortality in valvular reoperations for prosthetic valve dysfunction. Eur J Cardiothorac Surg ，2002， 22 （6）： 922-926.
7. 　Leontyev S， Borger MA， Modi P， et al. Redo aortic valve surgery： Influence of prosthetic valve endocarditis on outcomes. J Thorac Cardiovasc Surg， 2011， 142 （1）：99-105.
8. 　Tyers GF， Jamieson WR， Munro AI， et al. Reoperation in　 biological and mechanical valve populations： fate of the reoperative patient. Ann Thorac Surg，1995，60 （2 Suppl）：S464-S469.
9. 　Akins CW， Buckley MJ， Daggett WM， et al. Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. Ann Thorac Surg， 1998， 65 （6）：1545-1552.
10. 　Caus T， Albertini JN， Chi J， et al. Multiple valve replacement　 increases the risk of reoperation for structural degeneration of　 bioprosthese. J Heart Valve Dis， 1999， 8 （4）：376-383.
11. 　Gill IS， Masters RG， Pipe AL， et al. Determinants of hospital　 survival following reoperative single valve replacement. Can J　 Cardiol， 1999， 15 （11）：1207 -1210.
12. 　Vogt PR， Brunner-LaRocca H， Sidler P， et al. Reoperative surgery　 for degenerated aortic bioprostheses ： predictors for emergency　 surgery and reoperative mortality. Eur J Cardiothorac Surg， 2000， 17 （2）： 134-139.
13. 　Toker ME， Kirali K， Balkanay M， et al. Operative mortality after valvular reoperations. Heart Surg Forum， 2005，8 （4）： E280-E283.
14. 　Oz BS， Iyem H， Akay HT， et al. Risk factors for short- and long-term survival in patients undergoing re-replacement due to prosthetic valve dysfunction. Heart Vessels， 2006， 21 （6）：339-343.
15. 　Beurtheret S， Gariboldi V， Feier H， et al. Short-term results of　 repeat valve replacement：a predictive factor analysis. J Heart Valve Dis， 2010， 19 （3）：326-332.
16. [2012-03-21]. http：//www. scts. org.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Repeated Heart Valve Surgery in 325 Patients

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