Background : Reoperative valve surgery remains challenging, with high reported mortality. We conducted this retrospective analysis to identify risk factors for hospital deaths in a recent cohort of patients.
Methods : Between January 1, 1996 and December 31, 2001, 168 consecutive patients underwent reoperative valve surgery. Uni- and multivariate analyses were conducted and observed mortality was compared to predicted mortality (Euroscore).
Results : Observed hospital mortality was 7,7%. Euroscore predicted mortality was 10,7% ± 2,0% (Conf.Int. 95%). All deceased patients had had previous mitral valve surgery and 70% needed mitral surgery again. Revision for bleeding was needed in 3,6% and transfusion required in 39%. Mean additive Euroscore was 7,4± 2,3. Univariate analysis identified age (p=0,023), Euroscore (p=0,008), NYHA class (p=0,004), number of previous valve operations (p=0,002), blood creatinine (p=0,043), blood hemoglobine (p<0,001) and LDH (p<0,001) as risk factors for death, whereas Body Mass Index, gender, left ventricular ejection fraction and pulmonary arterial hypertension were not. Multivariate model (logistic regression) considering age, number of previous valve procedures, blood hemoglobine, blood urea nitrogen, blood creatinine and LDH predicted accurately death probability (surface under ROC curve = 0,97).
Conclusion : Reoperative valve surgery carries an acceptable risk in the current era. A very low rate of reoperation for bleeding was observed. Mortality was significantly lower than predicted by Euroscore. Advancing age, high Euroscore, NYHA class, number of previous valve operations (especially if mitral), decreased renal function and hemolysis were significant risk factors for hospital mortality.