Redo Valve Surgery—Current Status and Future Perspectives

Abstract

Surgeons are now facing the challenge of redo valve surgery because of the increasing number of elderly individuals in Japan. The incidence of bioprosthesis dysfunction has increased among the various surgical indications of redo valve surgery due to the preference of patients and a paradigm shift in prostheses from mechanical valves to bioprostheses. Previous studies reported that the clinical outcomes of reoperative valvular surgery have markedly improved due to the maneuver of myocardial protection, cardiopulmonary bypass strategies, and appropriate safer surgical approach. The general surgical outcomes of redo valve surgery have been reported as being similar to those of primary valve surgery; however, this is still controversial and has not yet been confirmed in some developed countries. Although the unique surgical technique of transcatheter valve-in-valve implantation for bioprosthetic dysfunction is promising, redo valve surgery may become more prevalent in the future. We here reviewed the current status of reoperative valve surgery and future perspectives including catheter-based surgical interventions.

Right mini-thoracotomy approach reduces hospital stay and transfusion of mitral or tricuspid valve reoperation with non-inferior efficacy: evidence from propensity-matched study

“…There were there patients in this study received the redo operation due to bioprosthesis failure, while other patients were confronted with the valve problem again. Although the inhospital mortality of reoperation has reduced significantly because of the myocardial protection improvement, new CPB strategies, and the appropriate approach, it is still challenging and risky for most cardiac surgeons (2). Major problem led by reoperation is the re-exposure of the heart, mostly attached to the sternum due to the extensive pericardial adhesions, which may contribute to the injury of cardiac structures.…”

“…However, valve reoperation is also quite challenging due to the difficulty in exposure of the incision. Conventional redo valve surgery routinely adopts the sternotomy as the incision, which may be highly risky in injuring the heart and great vessels (2). Compared with patients receiving initial valve operation, those receiving redo operations have significantly higher mortality and morbidity (3).…”

Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

“…Patients who have had valvular surgery are presenting more often for redo surgery, which further complicates surgical risk. 27…”

Sutureless Valve in Repeated Aortic Valve Replacement: Results from an International Prospective Registry

“…The most common surgical indication for RAVR is bioprosthetic structural valve deterioration and our study confirms the rising trend toward implantation of biological versus mechanical valves in the last decade. 8,18,19 With the introduction of the ViV TAVI concept, more patients will choose biological valve in order to avoid the risk of surgical procedure. Despite ViV TAVI is a less invasive strategy, ViV TAVI may complicate with coronary obstruction, high postprocedural gradients, malposition, and valve migration.…”

“…3 Redo surgery is associated with higher mortality and morbidity compared to primary AVR and the overall in-hospital mortality ranges from 2.3% to 17.6%. [4][5][6][7][8] This risk has brought surgeons to consider alternative strategies to improve surgical outcomes. 9,10 Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is considered a less invasive strategy; however, it is associated with specific complications and requires extensive preoperative work-up planned by the heart team.…”