Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678764
Oral Presentations
Sunday, February 17, 2019
DGTHG: Reoperation in der Herzklappenchirurgie
Georg Thieme Verlag KG Stuttgart · New York

In-hospital Outcome and Risk Predictors of Mortality after Redo Aortic Valve Surgery

S. Westhofen
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
R. Stiefel
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
E. Vettorazzi
2   Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
H. Reichenspurner
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
C. Detter
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. Januar 2019 (online)

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Objectives: The aim of the study was to analyze risk predictors of early morbidity and mortality after redo aortic valve surgery.

Materials and Methods: Between January 2009 and December 2017, 220 patients in our institution underwent a reoperation of the aortic valve (re-AVR). Mean age was 62.6 ± 13.2 years, 29% were female. Mean EuroSCORE II was 12.6 ± 11.1. Of the total cohort, 30.9% previously underwent a combined procedure, whereas 11.8% had coronary artery bypass grafting (CABG), and 10.4% of patients had more than one previous heart surgery. Previously implanted prostheses were biological in 86.4% and mechanical in 13.6%. Regression analyzes and receiver-operating characteristic curves identified independent predictors of death.

Results: Total in-hospital mortality for isolated re-AVR was 5.7%, when active endocarditis was excluded, it was 1.1% (p = 0.250). Combined procedures at reoperation (odds ratio [OR] 6.48; confidence interval [CI] 1.80–31.14; p = 0.003), New York Heart Association (NYHA) class ≥3 (OR 3.68; CI 1.17–13.47; p = 0.0009), and previous CABG (OR 11.85; CI 3.51–46.01; p < 0.001) were independent predictors for 30-day mortality. Overall morbidity was high, but tending to be lower in isolated AVR compared with combined procedures (postoperative low output: 15 vs. 9.2%, p = 0.222; stroke: 6.8 vs. 2.3%; p = 0.207; perioperative respiratory failure with tracheotomy: 6 vs. 5.7%, p > 0.99; acute renal insufficiency with new-onset dialysis: 10.5 vs. 5.7%, p = 0.326; myocardial infarction: 2.3 vs. 2.3%, p = 1.0; and pacemaker implantation: 25.6 vs. 14.9%, p = 0.066).

Conclusion: Significant independent risk predictors for in-hospital mortality were combined procedures at reoperation, NYHA class ≥3, and previous CABG. Perioperative risk in isolated nonendocarditis re-AVR is significantly lower and comparable to primary AVR. These results may impact the decision on therapy in the age of interventional strategies as an alternative for high-risk patients.