[Reasons for surgical reintervention and its prognosis after prosthesis valve replacement].

Abstract

Objective: To investigate the causes of surgical reintervention after prosthetic valve replacement and to evaluate the safety and effectiveness of valve reoperation. Methods: This retrospective case series study consecutively included 144 patients who underwent repeat cardiac valve surgery at the Department of Cardiothoracic Surgery, Nanjing First Hospital between July 2020 and July 2025. Patients were excluded if their initial procedure involved valve repair or transcatheter valve implantation, or if the previously implanted prosthetic valve was not treated during the reoperation. There were 80 males and 64 females. The age (M(IQR)) was 63(14) years (range:29 to 78 years).One hundred and forty patients (97.2%,140/144) underwent a second cardiac surgery, while 4 patients(2.8%,4/144) underwent a third operation.In the previous surgery, mitral, aortic and tricuspid valve replacement had been performed on 71.5%(103/144), 56.3%(81/144) and 2.1%(3/144) patients respectively, and 28.5%(41/144) patients had undergone concomitant mitral and aortic valve replacement. A total of 78 patients had previously received bioprosthetic valves (bioprosthetic group), and 66 patients had previously received mechanical valves (mechanical group). The causes of reintervention, all-cause mortality after reoperation, and the incidence of major perioperative complications were analyzed. Independent sample t-test, Mann-Whitney U test, Chi-square test or Fisher's exact test was used in between-group analysis. Kaplan-Meier method was performed on survival analysis. Univariate and multivariate Cox regression analyses were used to identify the risk factors for all-cause mortality after surgery in patients. Results: The interval from the previous surgerymedian was 11(9) years (range:3 months to 32 years). In the bioprosthetic group, the main causes of reintervention were structural valve deterioration (71.8%, 56/78) and prosthetic valve endocarditis (21.8%, 17/78). In the mechanical group, the leading causes were pannus or valve thrombosis (69.7%, 46/66) and paravalvular leak (22.7%, 15/66). Reoperations involved the mitral valve in 88 cases, the aortic valve in 62 cases, and the tricuspid valve in 3 cases. All patients underwent reoperation via median sternotomy, and 72.2% (104/144) received peripheral cannulation. The 30-day mortality rate was 6.3% (9/144). The incidences of low cardiac output syndrome, permanent pacemaker implantation, and prolonged mechanical ventilation were 10.4% (15/144), 8.3% (12/144), and 22.2% (32/144), respectively. The follow-up time was 12(12) months(range:0 to 42 months), 5 patients died during the follow-up period, among whom 4 died of cardiac causes and 1 died of non-cardiac causes. The Kaplan-Meier survival analysis showed that the 1-year survival rate of the patients after surgery was 90.8% (95%CI: 86.2% to 95.7%). The univariate and multivariate Cox regression analysis results indicated that glomerular filtration rate (HR=0.97, 95%CI: 0.95 to 1.00, P=0.019), severe tricuspid regurgitation (HR=6.41, 95%CI: 1.31 to 31.17, P=0.022), prosthetic valve endocarditis (HR=3.67, 95%CI: 1.06 to 12.73, P=0.041), preoperative cardiogenic shock (HR=7.70, 95%CI: 3.14 to 27.73, P=0.002), and emergency or salvage surgery (HR=7.39, 95%CI: 1.82 to 30.09, P=0.005) were independent risk factors for postoperative mortality in patients undergoing revalvularization. Conclusions: Structural valve deterioration is the primary cause of surgical reintervention after bioprosthetic valve replacement, whereas pannus or valve thrombosis and paravalvular leak are the main reasons after mechanical valve replacement. Preoperative renal insufficiency, severe tricuspid regurgitation, prosthetic valve endocarditis, cardiogenic shock, and emergency surgery are significantly associated with increased postoperative mortality after valve reoperation.