Pradeep Narayan, Arnaldo Dimagli, Jeremy Chan, Tim Dong, Charles Tan, Tugba Aydin, Daniel Paul Fudulu, Gianni Davide Angelini
{"title":"主动脉瓣手术再手术的结果：来自23年来国家登记的数据。","authors":"Pradeep Narayan, Arnaldo Dimagli, Jeremy Chan, Tim Dong, Charles Tan, Tugba Aydin, Daniel Paul Fudulu, Gianni Davide Angelini","doi":"10.1007/s12055-025-01980-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Over the past two decades, early mortality following re-operative aortic valve surgery has declined significantly; however, it remains higher than that observed after primary isolated valve replacement. We sought to examine temporal trends and identify independent predictors of adverse outcomes in patients undergoing re-operative aortic valve surgery.</p><p><strong>Method: </strong>The study included all patients undergoing re-operative aortic valve replacement (AVR) in the United Kingdom between January-1996 and March-2019 including those with multiple previous operations and those undergoing additional procedures. Data was obtained from the National Institute of Cardiovascular Outcomes Research database. The primary objective was to assess in-hospital mortality trends. Secondary objective was to identify risk factors for in-hospital mortality. Multivariable analysis was carried out to identify independent risk factors for in-hospital mortality.</p><p><strong>Results: </strong>During the study period, 6,109 re-operative aortic valve surgeries were carried out in the United Kingdom. There were 1,973(32%) females, median age was 69(60-76) years with median duration between the initial and the reoperation being 7(2-13) years. Bio-prosthetic valves were more commonly explanted compared to mechanical valves: 4,125(68%) vs. 1,641(27%). Mortality for elective re-operative cases was 4.8% (<i>n</i> = 166). After adjustments, surgery after 2007, age, number of previous operations, urgency of operation, gender, concomitant procedures, pre-operative chronic kidney disease and endocarditis, were important predictors of outcomes. Mortality showed a downward trend during the study period (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>With advances in management strategies, mortality following re-operative AVR continues to decline, but still remains significant. Structural degeneration of bioprosthetic valves continues to be the most common indication for re-operation Emergency re-operations are associated with substantially higher mortality rates; therefore, close follow-up of these patients is essential to facilitate timely elective re-intervention before clinical deterioration.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01980-1.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 9","pages":"1125-1135"},"PeriodicalIF":0.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373612/pdf/","citationCount":"0","resultStr":"{\"title\":\"Outcomes of reoperative aortic valve surgery: data from a national registry over 23 years.\",\"authors\":\"Pradeep Narayan, Arnaldo Dimagli, Jeremy Chan, Tim Dong, Charles Tan, Tugba Aydin, Daniel Paul Fudulu, Gianni Davide Angelini\",\"doi\":\"10.1007/s12055-025-01980-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Over the past two decades, early mortality following re-operative aortic valve surgery has declined significantly; however, it remains higher than that observed after primary isolated valve replacement. We sought to examine temporal trends and identify independent predictors of adverse outcomes in patients undergoing re-operative aortic valve surgery.</p><p><strong>Method: </strong>The study included all patients undergoing re-operative aortic valve replacement (AVR) in the United Kingdom between January-1996 and March-2019 including those with multiple previous operations and those undergoing additional procedures. Data was obtained from the National Institute of Cardiovascular Outcomes Research database. The primary objective was to assess in-hospital mortality trends. Secondary objective was to identify risk factors for in-hospital mortality. Multivariable analysis was carried out to identify independent risk factors for in-hospital mortality.</p><p><strong>Results: </strong>During the study period, 6,109 re-operative aortic valve surgeries were carried out in the United Kingdom. There were 1,973(32%) females, median age was 69(60-76) years with median duration between the initial and the reoperation being 7(2-13) years. Bio-prosthetic valves were more commonly explanted compared to mechanical valves: 4,125(68%) vs. 1,641(27%). Mortality for elective re-operative cases was 4.8% (<i>n</i> = 166). After adjustments, surgery after 2007, age, number of previous operations, urgency of operation, gender, concomitant procedures, pre-operative chronic kidney disease and endocarditis, were important predictors of outcomes. Mortality showed a downward trend during the study period (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>With advances in management strategies, mortality following re-operative AVR continues to decline, but still remains significant. Structural degeneration of bioprosthetic valves continues to be the most common indication for re-operation Emergency re-operations are associated with substantially higher mortality rates; therefore, close follow-up of these patients is essential to facilitate timely elective re-intervention before clinical deterioration.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01980-1.</p>\",\"PeriodicalId\":13285,\"journal\":{\"name\":\"Indian Journal of Thoracic and Cardiovascular Surgery\",\"volume\":\"41 9\",\"pages\":\"1125-1135\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373612/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12055-025-01980-1\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-01980-1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/17 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Outcomes of reoperative aortic valve surgery: data from a national registry over 23 years.
Objective: Over the past two decades, early mortality following re-operative aortic valve surgery has declined significantly; however, it remains higher than that observed after primary isolated valve replacement. We sought to examine temporal trends and identify independent predictors of adverse outcomes in patients undergoing re-operative aortic valve surgery.
Method: The study included all patients undergoing re-operative aortic valve replacement (AVR) in the United Kingdom between January-1996 and March-2019 including those with multiple previous operations and those undergoing additional procedures. Data was obtained from the National Institute of Cardiovascular Outcomes Research database. The primary objective was to assess in-hospital mortality trends. Secondary objective was to identify risk factors for in-hospital mortality. Multivariable analysis was carried out to identify independent risk factors for in-hospital mortality.
Results: During the study period, 6,109 re-operative aortic valve surgeries were carried out in the United Kingdom. There were 1,973(32%) females, median age was 69(60-76) years with median duration between the initial and the reoperation being 7(2-13) years. Bio-prosthetic valves were more commonly explanted compared to mechanical valves: 4,125(68%) vs. 1,641(27%). Mortality for elective re-operative cases was 4.8% (n = 166). After adjustments, surgery after 2007, age, number of previous operations, urgency of operation, gender, concomitant procedures, pre-operative chronic kidney disease and endocarditis, were important predictors of outcomes. Mortality showed a downward trend during the study period (p < 0.001).
Conclusion: With advances in management strategies, mortality following re-operative AVR continues to decline, but still remains significant. Structural degeneration of bioprosthetic valves continues to be the most common indication for re-operation Emergency re-operations are associated with substantially higher mortality rates; therefore, close follow-up of these patients is essential to facilitate timely elective re-intervention before clinical deterioration.
Graphical abstract:
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01980-1.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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