The in-hospital risk of rereplacement of dysfunctional mitral and aortic valves.

From January 1, 1972, to January 1, 1981, 1282 consecutive valve replacements were performed at the Peter Bent Brigham Hospital. Fifty-eight of these (4.5%) were rereplacements: 14 for prosthetic valve subacute bacterial endocarditis (SBE), 29 for primary valve dysfunction (PVD) and 15 for perivalvular leak (PVL). Aortic rereplacement was done in 27 patients (eight for SBE, 10 for PVD and nine for PVL) and mitral rereplacement in 31 patients (six for SBE, 19 for PVD and six for PVL). Twenty-six patients were in New York Heart Association functional class III and 32 were in class IV. Ten class IV patients underwent emergency valve replacement (three for SBE, two for PVD and five for PVL). The overall in-hospital mortality rate for valve rereplacement was 14% (eight of 58 patients). For mitral valve rereplacement it was 13% (four of 31), compared with 6.4% (19 of 295) for initial mitral valve replacement. For aortic valve rereplacement, the mortality rate was 15% (four of 27), compared with 5.2% (23 of 440) for initial aortic valve replacement. The cause of death was low cardiac output in six patients, hemorrhage in one patient and sepsis in one patient. All of the patients who died were in functional class IV (p = 0.018). The in-hospital risk for rereplacement of a dysfunctional aortic or mitral valve is no different from that for primary valve replacement unless the patient deteriorates to class IV and requires an emergent operation.