Surgical Complexity and Outcome of Patients Undergoing Re-do Aortic Valve Surgery

Abstract

ObjectivesRe-do aortic valve surgery carries a higher mortality and morbidity compared with first time aortic valve replacement (AVR) and often requires concomitant complex procedures. Transcatheter aortic valve replacement (TAVR) is an option for selective patients. The aim of this study is to present our experience with re-do aortic valve procedures and give an insight into the characteristics of these patients and their outcomes.MethodsRetrospective review of 80 consecutive re-do aortic valve procedures.ResultsMean patients’ age was 51.80±18.73 years. Aortic regurgitation (AR) was present in 51 (65.4%) patients and aortic stenosis (AS) in 38 (48.7%). Indications for reoperation were: infective endocarditis (IE) (23.8%), bioprosthetic degeneration (12.5%), mechanical valve dysfunction (5%), paravalvular leak (6.2%), patient–prosthesis mismatch (3.8%), native valve disease (25%), aortic aneurysm, pseudoaneurysm and dissection (35%), aortic root/homograft degeneration (27.5%). Forty-one (51.2%) patients underwent re-do AVR, 39 (48.8%) re-do complex aortic valve surgery (28 root, 23 ascending aorta and 6 hemiarch procedures) and 37.5% concomitant procedures. A bioprosthesis was implanted in 43.8%, a mechanical valve in 37.5%, a composite graft in 2.5%, a Biovalsalva graft in 6.2% and a homograft in 10% of patients. In-hospital mortality was 3.8% and incidence of major complications was low.ConclusionsA significant proportion of patients were young (61%<60 y), required complex aortic procedures (49%) or presented with contraindications for TAVR (mechanical valve, AR, IE, proximal aortic disease, need for concomitant surgery). Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptable mortality and morbidity in a specialised aortic centre.

A 20-year experience with cryopreserved allografts as the valve replacement of choice in aortic root reconstruction for destructive endocarditis with abscess formation

“…Despite this drawback of structural valve degeneration, we believe that the abovementioned advantages, including infection control and mitigation of IE-related mortality, outweigh this long-term risk. Moreover, in the case of allograft degeneration, valve-in-valve transcatheter aortic valve replacement may then offer a realistic solution especially in older patients [ 19 , 20 ].…”

Use of a sutureless aortic valve in reoperative aortic valve replacement

“… 5 ViV TAVR has arisen as an attractive solution, offering an alternative to the challenges of redo SAVR. 9 Multiple studies have shown ViV TAVR to have at least similar (if not better) outcomes and shorter hospital stays than redo SAVR. 10 However, significant limitations of ViV TAVR still exist, and long-term data (>5 years) are still pending.…”

Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results

“…An invasive surgery such as the Commando procedure guarantees, in case of IE, complete debridement of the infective material and, in case of the other described pathological process, a lower risk of prosthesis dehiscence, paravalvular leak and patient–prosthesis mismatch, which are all possible cause of re-intervention [ 39 , 40 ]. De Olivera NC et al [ 12 ] described every case of reoperation after the Commando procedure.…”