Reoperation for prosthetic heart valve dysfunction: 19 years' experience.

Between September 1968 and October 1987, 152 patients (66 males and 86 females; age range, 15 to 79 years) underwent 1 or more reoperations (total, 179) for prosthetic valve dysfunction at our hospital. In this report, we present material and statistics reflecting our experience with the last reoperation in these 152 patients. The procedures involved the mitral valve in 93 patients, the aortic valve in 38 patients, double valves (aortic and mitral) in 19, and the tricuspid valve in 2. Sixty-five patients were operated on for mechanical valve dysfunction, and 87 for tissue valve dysfunction. The modes of valve dysfunction that indicated surgery were primary valve failure (85 patients), valvular thrombosis and valve-related thromboembolic episodes (27 patients), paravalvular leak (25 patients), prosthetic valve endocarditis (14 patients), and hemolysis (1 patient). Three patients were in New York Heart Association functional Class II, 77 were in Class III, and 61 were in Class IV; the remaining 11 cases were emergencies. The 30-day operative mortality was 14.5%, the 5-year survival was 75%, and the 10-year survival was 63%. The preoperative functional class and the mode of valve dysfunction significantly influenced both early and late mortality.