afraidofsurgery
Well-known member
This is a pre-publication abstract available on the Heart Surgery Forum website. Since this forum talks about repeat surgeries often, I thought some statistics should be posted. NOTE: This is not a complete and thorough literature search, I came across this article and posted it since it's brand new data. Also note this is not a US study. I'm no expert on the subject, but these reopration rates seem to have higher mortality associated than first-operation rates I've seen. I can do a more complete lit search if anyone thinks this would be helpful.
Operative Mortality after Valvular Reoperations
Mehmet Erdem Toker A1, Kaan Kirali A1, Mehmet Balkanay A1, Ercan Eren A1, Yücel Özen A1, Mustafa Güler A1, Cevat Yakut A1
A1 Department of Cardiovascular Surgery, Kos¸uyolu Heart and Research Hospital, Istanbul, Turkey
Abstract:
Background: To determine the incidence and risk factors of mortality and morbidity in valvular reoperations.
Methods: Between January 1993 and December 2003, 309 valvular reoperations were performed. The reasons for reoperations were reconstructive surgery in first operation (110 patients, 35.5%), prosthetic valve endocarditis (12 patients, 3.8%), periprosthetic leakage (32 patients, 10.3%%), new valve degenerations (12 patients, 3.8%), bioprosthetic dysfunction (92 patients, 29.7%), acute thrombotic stuck valve (30 patients, 9.7%), and pannus formation (21 patients, 6.7%). Mitral valves were replaced in 235 patients, aortic valves were replaced in 32 patients, 24 patients had aortic and mitral valve replacements, 2 patients had mitral and tricuspid valve replacements, and reconstruction of periprosthetic leakage was held in 16 patients. 264 patients had elective surgery, whereas 45 were operated on emergeny basis.
Results: Hospital mortality was 14.23%. Mortality rate was found to be 10.6% for elective cases and 35.5% for emergency cases. Permanent pacemaker was required in 12 patients, 3 patients had cerebrovascular events, and mediastinitis was observed in 1 patient. Multivariate analysis demonstrated that age >60 (P = .006; OR 7.3, 95% CI 1.7-30.1), emergency surgery (P = .001; OR 8.1, 95% CI 2.4-27.7), preoperative cerebrovascular accident (P = .003; OR 11.8, 95% CI 2.458.7), and concomitant ascending aorta replacement (P < .001; OR 27.4, 95% CI 6-127) were independent risk factors.
Conclusion: Valvular reoperations can be carried out with acceptable morbidity and mortality in elective operations but mortality rates are still very high in emergent cases.
Operative Mortality after Valvular Reoperations
Mehmet Erdem Toker A1, Kaan Kirali A1, Mehmet Balkanay A1, Ercan Eren A1, Yücel Özen A1, Mustafa Güler A1, Cevat Yakut A1
A1 Department of Cardiovascular Surgery, Kos¸uyolu Heart and Research Hospital, Istanbul, Turkey
Abstract:
Background: To determine the incidence and risk factors of mortality and morbidity in valvular reoperations.
Methods: Between January 1993 and December 2003, 309 valvular reoperations were performed. The reasons for reoperations were reconstructive surgery in first operation (110 patients, 35.5%), prosthetic valve endocarditis (12 patients, 3.8%), periprosthetic leakage (32 patients, 10.3%%), new valve degenerations (12 patients, 3.8%), bioprosthetic dysfunction (92 patients, 29.7%), acute thrombotic stuck valve (30 patients, 9.7%), and pannus formation (21 patients, 6.7%). Mitral valves were replaced in 235 patients, aortic valves were replaced in 32 patients, 24 patients had aortic and mitral valve replacements, 2 patients had mitral and tricuspid valve replacements, and reconstruction of periprosthetic leakage was held in 16 patients. 264 patients had elective surgery, whereas 45 were operated on emergeny basis.
Results: Hospital mortality was 14.23%. Mortality rate was found to be 10.6% for elective cases and 35.5% for emergency cases. Permanent pacemaker was required in 12 patients, 3 patients had cerebrovascular events, and mediastinitis was observed in 1 patient. Multivariate analysis demonstrated that age >60 (P = .006; OR 7.3, 95% CI 1.7-30.1), emergency surgery (P = .001; OR 8.1, 95% CI 2.4-27.7), preoperative cerebrovascular accident (P = .003; OR 11.8, 95% CI 2.458.7), and concomitant ascending aorta replacement (P < .001; OR 27.4, 95% CI 6-127) were independent risk factors.
Conclusion: Valvular reoperations can be carried out with acceptable morbidity and mortality in elective operations but mortality rates are still very high in emergent cases.
