Clin Res Cardiol 96:Suppl 2 (2007)

P371 - Evaluation of the perioperative risk of redo AVR
 
S. Christiansen1, A. Hoffman1, R. Autschbach1
 
1Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsklinikum Aachen, Aachen;
 
Until now, the operative risk for redo aortic valve replacement (AVR) remains a topic of debate. Therefore, we performed a retrospective study to evaluate the perioperative risk of this cardiac procedure.
Sixty-three patients (53 male, 10 female) underwent redo AVR from 2001-2005 in our department. 41 bioprostheses had to be replaced for degeneration and/or paravalvular leakage 10.4 +/- 4.0 years after implantation and 18 mechanical prostheses were changed due to thrombosis and/or paravalvular leakage 6.22 +/- 2.1 years after implantation. Four patients with a bicuspid aortic valve underwent a mechanical AVR after a primary reconstructive procedure. We compared the perioperative course of the redo AVR (Group 2) with the primary procedure (group 1) and performed a statistical analysis with the t-test for quantitative and the McNemar test for qualitative data. Due to multiple testing, a Bonferroni correction was performed. A p-value less than 0.05 was considered significant.
The most important data are shown in Table 1. 52 patients received a mechanical prosthesis and 8 a biological one. Three patients underwent a refixation of the protheses for a paravalvular leakage 1, 2, and 7 years after implantation. 39 patients had an uneventful postoperative course. Four patients expired after redo AVR: Two patients died due to a multi-organ failure, one patient suffered from an intestinal ischemia requiring bowel resection, and one patient expired due to an aortic rupture during resuscitation.

Table 1
  Group 1 Group 2 p-value
Elective Procedure 57 48 0.049
Urgent Procedure 1 13 0.0013
Emergent Procedure 5 2 ns
Duration of surgery (minutes) 191.7 +/- 31.6 261.7 +/- 49.5 0.0004
Duration of CPB (minutes) 101.3 +/- 28.4 130.3 +/- 37.1 0.0004
Duration of X-clamp (minutes) 66.4 +/- 20.6 80.4 +/- 23.4 0.0008
Diameter of the implanted prostheses (mm) 27.0 +/- 2.6 26.2 +/- 2.0 0.02
Duration of mechanical ventilation (minutes) 14.2 +/- 5.1 17.0 +/- 13.8 ns
Duration on ICU (days) 2.3 +/- 1.1 2.9 +/- 2.1 ns
Duration on the normal ward (days) 10.7 +/- 4.6 10.2 +/- 2.3 ns
Need for pacemaker insertion 2 8 0.033
Reexploration for bleeding 2 4 ns
Renal insufficiency 4 2 ns
Cerebral Confusion 0 5 nc
LCOS (treated with an IABP) 0 4 nc
Wound infection 1 2 ns
Intestinal Ischemia 0 1 nc
CPB = cardiopulmonary bypass, ICU = intensive care unit, LCOS = Low Cardiac Output Syndrome, IABP = Intra-aortic Balloon Pump, ns = not significant, nc = not calculated

Redo AVR is associated with an enhanced perioperative risk compared with a primary procedure. Therefore, these patients should be referred early for surgery to avoid high-risk emergency operations.
 

http://www.abstractserver.de/dgk2007/ht/abstracts/P371.htm