Risk factors for short- and long-term survival in patients undergoing re-replacement due to prosthetic valve dysfunction.

The purpose of this study was to investigate the effect of preoperative, intraoperative, and postoperative variables on early, mid-, and long-term outcome of re-replacement of prosthetic valves. Between February 1989 and January 2004, 192 patients who were treated for prosthetic valve dysfunction were analyzed retrospectively using a computer-based databank system. Prosthetic valve re-replacements were performed, including 164 cases of second, 10 cases of third, and 2 cases of fourth valve re-replacement. The number of re-replacements amounted to 6.1% (n = 176) of total valvular surgery. There were 90 male patients (46.8%) and the mean age was 61.6 +/- 8.3 years. Median follow-up time was 7.8 years. Hospital mortality was 11.7% (n = 14). Low ejection fraction (EF), advanced New York Heart Association (NYHA) functional class, prosthetic valve endocarditis, and pulmonary edema were found to be predictors of early mortality. The 1-, 5-, and 10-year actuarial survival rates were 92% +/- 3%, 78% +/- 3%, and 45% +/- 2%, respectively. Multivariate analysis revealed that NYHA class IV, low EF, prosthetic valve endocarditis, advanced age, left ventricular end-systolic diameter (LVESD) >50 mm, and double valve re-replacement were independent predictors of late mortality. In our study NYHA class IV, low EF, prosthetic valve endocarditis, and LVESD >50 mm were found to be risk factors for both hospital mortality and long-term survival. In addition, pulmonary edema, advanced age, and double valve replacement were also risk factors over the long term. Aggressive treatment of endocarditis and early re-replacement before aggravation of left ventricle function will improve the results.