The Risks and Benefits of Reoperative Aortic Valve Replacement

  • Vincent A. Gaudiani
  • Gary L. Grunkemeier
  • Luis J. Castro
  • Audrey L. Fisher
  • YingXing Wu


Background: Many patients are advised to have mechanical aortic valve replacement (AVR) because their expected longevity exceeds that of tissue prostheses. This strategy may avoid the risks of reoperation but exposes patients to the risks of long-term anticoagulation therapy. Which risk is greater?

Methods: We reviewed the records of 1213 consecutive, unselected AVR patients, 60% of whom had concomitant procedures, who were treated from 1994 through 2002. Of these patients, 887 were first-time AVR patients, and 326 underwent reoperation. Of the reoperation patients, 134 had previously undergone AVR (redo). We constructed a risk model from these 1213 cases to assess the factors that predicted mortality and to examine the extent to which reoperation affected outcome.

Results: Multiple logistic regression analysis indicated that factors of reoperation and redo operation did not predict mortality. In fact, the mortality rate was 4.1% for all first AVR operations and 3.1% for all reoperation AVR (P = .891). Significant predicting factors (with odds ratios) were reoperative dialysis (6.03), preoperative shock (3.68), New York Heart Association class IV (2.20), female sex (1.76), age (1.61), and cardiopulmonary bypass time (1.26).

Conclusions: In this series, the risk of reoperation AVR is comparable with the published risks of long-term warfarin sodium (Coumadin) administration after mechanical AVR. Any adult who requires AVR may be well advised to consider tissue prostheses.


Akins CW. 1995. Results with mechanical cardiac valvular prostheses. Ann Thorac Surg 60:1836-44.\nAkins CW, Buckley MJ, Daggett WM, et al. 1998. Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. Ann Thorac Surg 65:1545-51.\nAkins CW, Hilgenberg AD, Vlahakes GJ, MacGillivray TE, Torchiana DF, Madsen JC. 2002. Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting. Ann Thorac Surg 74:1098-106.\nButchart EG, Payne N, Li HH, Buchan K, Maudana K, Grunkemeier GL. 2002. Better anticoagulation control improves survival after valve replacement. J Thorac Cardiovasc Surg 123:715-23.\nCarrier M, Pellerin M, Perrault LP, et al. 2001. Aortic valve replacement with mechanical and biologic prosthesis in middle-aged patients. Ann Thorac Surg 71(suppl):S253-6.\nDavid TE, Ivanov J, Armstrong S, Feindel CM, Cohen G. 2001. Late results of heart valve replacement with the Hancock II bioprosthesis. J Thorac Cardiovasc Surg 121:268-77.\nGrover FL, Hammermeister KE, Burchfiel C. 1990. Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. Ann Thorac Surg 50:12-28.\nGrunkemeier GL, Jin R. 2001. Receiver operating characteristic curve analysis of clinical risk models. Ann Thorac Surg 72:323-6.\nGrunkemeier GL, Wu Y, Furnary AP. 2003. Cumulative sum techniques for assessing surgical results. Ann Thorac Surg 76:663-7.\nHammermeister KE, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. 2000. Outcomes 15 years after replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs Randomized Trial. J Am Coll Cardiol 36:1152-8.\nHammermeister KE, Sethi GK, Henderson WG, Oprian C, Kim T, Rahimtoola S. 1993. A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis: Veterans Affairs Cooperative Study on Valvular Heart Disease. N Engl J Med 328:1289-96.\nHosmer DW, Lemeshow S. 1980. A goodness-of-fit test for the multiple logistic regression model. Commun Stat A10:1043-69.\nKon ND, Riley RD, Adair SM, Kitzman DW, Cordell AR. 2002. Eight-year results of aortic root replacement with the Freestyle stentless porcine aortic root bioprosthesis. Ann Thorac Surg 73:1817-21.\nOxenham H, Bloomfield P, Wheatley DJ, et al. 2003. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart 89:715-21.\nPeterstein DS, Cen Y, Cheruvu S, et al. 1999. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. J Thorac Cardiovasc Surg 117:890-7.\nRahimtoola SH. 2003. Choice of prosthetic heart valve for adult patients. J Am Coll Cardiol 41:893-904.\nSidhu P, O'Kane H, Ali N, et al. 2001. Mechanical or bioprosthetic valves in the elderly: a 20-year comparison. Ann Thorac Surg 71(suppl):S257-60.\nTaylor KM. 2003. The Edinburgh heart valve study. Heart 89:697-8.\n
How to Cite
Gaudiani, V., Grunkemeier, G., Castro, L., Fisher, A., & Wu, Y. (2005). The Risks and Benefits of Reoperative Aortic Valve Replacement. The Heart Surgery Forum, 7(2), E170-E173.

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