Clinical Research – Redo surgical aortic valve replacement: An outdated technique in the era of valve-in-valve procedures?

Johannes Petersen, Roman Stiefel, Sumi Westhofen, Eik Vettorazzi, Till Demal, Beate Reiter, Björn Sill, Lenard Conradi, Yousuf Al Assar, Hermann Reichenspurner, Christian Detter

Background: The treatment of degenerative prosthetic aortic valves is increasingly important. However, redo surgical aortic valve replacement (Re-SAVR) carries higher perioperative risks than primary surgical aortic valve replacement.

Aim: This study aims to identify predictors of early morbidity and death after Re-SAVR.

Methods: A retrospective analysis of 220 patients scheduled for elective Re-SAVR between 2009 and 2017 was conducted. Patients were divided into isolated (n = 87) and combined (n = 133) redo procedures. The primary endpoint was in-hospital death, and secondary endpoints were postoperative complications, such as stroke, dialysis and pacemaker implantation. Regression analysis identified independent predictors of death.

Results: Among the patients undergoing Re-SAVR (mean age, 62.6 ± 13.2 years; 71% male; mean EuroSCORE II, 12.6 ± 11.1%), 86.4% received biological prostheses and 13.6% received mechanical pros-theses. The in-hospital death rate was 5.7% for isolated Re-SAVR and 18.0% for combined procedures (P = 0.003). Excluding patients with endocarditis, the in-hospital death rate was 0% for isolated Re-SAVR and 19.7% for combined procedures (P = 0.002). The incidence of postoperative complications after an isolated procedure was similar to that after a combined procedure. Independent predictors of 30-day death were previous coronary artery bypass grafting (odds ratio: 14.12, 95% confidence interval: 4.40–51.35;P < 0.001), a combined procedure (odds ratio: 7.01, 95% confidence interval: 2.09–31.54; P = 0.004) and New York Heart Association functional class III/IV (odds ratio: 3.73, 95% confidence interval: 1.31–12.58;P = 0.020).

Conclusions: The perioperative risk of death after isolated Re-SAVR in patients without endocarditiswas 0%. Independent predictors of in-hospital death included previous coronary artery bypass graft-ing, combined procedures and New York Heart Association class III/IV. These findings may inform thedecision-making process of the heart

• Redo surgery

• Aortic valve surgery
• Valve-in-valve procedure

• Abbreviations
• Background
• Methods
• Results
• Discussion
• Conclusions

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