Characteristics and Outcomes of Patients With Severe Bioprosthetic Aortic Valve Stenosis Undergoing Redo Surgical Aortic Valve Replacement
Background—With improved event-free survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. We sought to a) identify of the characteristics of patients with severe bioprosthetic PAS undergoing redo AVR, and b) assess the outcomes of these patients, along with factors associated with adverse outcomes.
Methods and Results—We studied 276 patients with severe bioprosthetic PAS (64±16 years, 58% men) that underwent redo-AVR between 2000-12 (excluding mechanical PAS, severe other valve disease and transcatheter AVR). Society of Thoracic Surgeons (STS) score was calculated. Severe PAS was defined as AV area <0.8 cm2, mean AV gradient ≥40 mm Hg and/or dimensionless index <0.25. A composite outcome of death and congestive heart failure (CHF) admission was recorded. Mean STS score and mean AV gradients were 8±8 and 53±17 mm Hg, while 28% had >II+ aortic regurgitation (AR). Only 39% had an isolated redo AVR, the rest were combination surgeries (coronary bypass and/or aortic surgeries). At 4.2±3 years, 64 (23%) patients met the composite endpoint (48 deaths and 19 CHF admissions, 2.5% 30-day deaths). On multivariable Cox survival analysis, higher STS score (HR 1.35), higher grades of AR (HR 1.29) and higher right ventricular systolic pressure or RVSP (HR 1.3) were associated with worse longer-term outcomes (all p<0.01).
Conclusions—At an experienced center, in patients with severe bioprosthetic PAS undergoing redo AVR, the majority undergo combination surgeries but have excellent outcomes.
- Received February 9, 2015.
- Revision received August 10, 2015.
- Accepted September 2, 2015.