Third-time aortic valve replacement: patient characteristics and operative outcome.

BACKGROUND: Reoperative cardiac surgery is being performed with increasing frequency. Third-time aortic valve surgery remains a rare procedure. We retrospectively analyzed the outcome of third-time aortic valve replacement (AVR) at our institution.

METHODS: Between 1990 and 2005, 49 patients underwent third-time AVR. Data analyzed included preoperative patient characteristics, type of preexisting aortic valve prosthesis, prosthetic valve pathology necessitating third-time AVR, postoperative morbidity and mortality, and echocardiographic data.

RESULTS: The mean age was 47.4 +/- 17 years. The mean interval between the first and second operation was 8.7 +/- 5.7 years, and between the second and third operation it was 10.2 +/- 5.6 years. Prosthetic valves at the time of second AVR included 32 homografts (65.4%), 11 mechanical prostheses (22.4%), and 6 xenografts (12.2%). At third-time AVR, 29 patients (59.2%) received a homograft or autograft, 12 (24.5%) received a mechanical valve, and 8 (16.3%) received a xenograft. In-hospital mortality was 4.1%. The mean follow-up was 80 +/- 69 months. Freedom from reoperation was 84% +/- 6% at 5 years and 65% +/- 11% at 10 years. Long-term survival was 79% +/- 6% at 5 years and 73% +/- 7% at 10 years. Multivariate analysis showed that age, female sex, and postoperative high left ventricular mass were factors associated with decreased long-term survival. Mean left ventricular mass decreased from 320 +/- 133 g to 263 +/- 102 g at 1 year postoperatively (p = 0.01).

CONCLUSIONS: Third-time AVR can be performed with low operative mortality, low cumulative operative mortality, and satisfactory long-term survival and freedom from reoperation. The procedure results in significant regression of left ventricular mass.