Author + information
- Faten Triki1,
- Rania Gargouri2,
- Walid Jomaa2,
- Dorra Abid1,
- Rania Hammami1,
- Leila Abid1 and
- Samir Kammoun1
Surgical reintervention (or redux surgery) for prosthetic valve (PV) replacement is increasingly performed nowadays. Nonetheless, this intervention is not devoid from adverse outcomes including higher morbidity and mortality rates than in the index surgery. We sought to study the causes and the in-hospital prognosis of such procedures.
This is an observational retrospective study. All consecutive patients undergoing redux surgery for PV replacement between January 2010 and December 2015 in a Tunisian tertiary care center were included. We studied the causes for redux surgery and predictive factors of in-hospital death.
Thirty seven patients were included of whom 22 (59.5%) were female. Mean age was 38 years (range 19-60). Indication for the index surgery was a rheumatic valve disease in 28 (76.3%) cases. Redux surgery was a mitral PV replacement in 22 (59.5%) patients, an aortic PV replacement in 9 (24.3%) patients and a double mitral and aortic PV replacement in 6 (16.2%) patients. Indication for PV replacement was endocarditis in 13 (35.1%) cases and PV thrombosis in 10 (27%) cases. Others causes for redux surgery included stenotic PV dysfunction in 5 (13.5%) cases, significant progression of another valve disease in 5 (13.5%) cases, significant paravalvular leaks in 2 (5.2%) cases and valve mismatch in 2 (5.4%) cases. In-hospital mortality rate was 21.6%. Predictive factors of in-hospital mortality in univariate analysis were PV endocarditis (p=0.004), an urgent surgery (p=0.001), a preoperative III or IV NYHA class (p=0.002), anemia (p=0.004), a low pre-operative left ventricular ejection fraction (LVEF) (p=0.006), a left ventricular end-systolic diameter >58 mm (p=0.004) and pre-operative systolic pulmonary artery pressure >50 mmHg (p=0.021). In multivariate analysis, infective endocarditis, low preoperative LVEF and NYHA class II or IV were the only factors independently associated to in-hospital death.
Redux surgery for PV replacement remains at high risk of death. Infective endocarditis, high NYHA class and reduced LVEF are independent predictors for in-hospital death.