Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Yoonjin Kang, Nazla Amanda Soehartono, Jae Woong Choi, Kyung Hwan Kim, Ho Young Hwang, Joon Bum Kim, Hong Rae Kim, Seung Hyun Lee, Yang Hyun Cho
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Abstract

Background:  As redo surgical aortic valve replacement (AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR.

Methods and results:  This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (hazard ratio [HR]: 3.990, p = 0.014), longer cardiopulmonary bypass time (HR: 1.006, p = 0.037), and lower left ventricular ejection fraction (LVEF) (HR: 0.956, p = 0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival.

Conclusion:  The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for nonendocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.

人工瓣膜置换术失败者重做主动脉瓣置换术的近期疗效。
背景:由于重做手术主动脉瓣置换术(AVR)的风险相对较高,瓣中瓣膜经导管主动脉瓣置换术已成为治疗失败假体的替代方法。然而,大多数研究已经过时。本研究评估了目前重做瓣膜置换术的临床效果:这项研究纳入了 2010 年至 2021 年期间在四个三级中心因人工瓣膜故障而接受重做 AVR 的 324 名患者。主要结果是手术死亡率。次要结果为总生存率、心源性死亡和主动脉瓣相关事件。采用逻辑回归分析、聚类 Cox 比例危险模型和竞争风险分析来评估独立风险因素。242 名无心内膜炎的患者和 82 名有心内膜炎的患者接受了重做主动脉瓣置换术。手术总死亡率为 4.6%(15 例死亡)。排除心内膜炎患者后,重做房室重建术的手术死亡率降至 2.5%。多变量分析显示,心内膜炎(HR 3.990,P=0.014)、较长的心肺旁路时间(HR 1.006,P=0.037)和较低的左心室射血分数(LVEF)(HR 0.956,P=0.034)是手术死亡率的风险因素。心内膜炎和较低的 LVEF 是总生存率的独立预测因素:结论:因人工瓣膜心内膜炎而再次手术导致再次进行 AVR 的风险相对较高。非心内膜炎的重做自体瓣膜置换术结果非常好。我们的研究结果表明,没有心内膜炎的患者,尤其是 LVEF 可以接受的患者,可以安全地接受重做自体瓣膜置换术。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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