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| Outcomes of Reoperative Aortic Valve Replacement Following Previous Sternotomy | ||||||||||||||||||||||||||||||||||||
Damien J. LaPar, Zequan Yang, R. Ramesh Singh, T. Brett Reece, Cory D. Maxwell, Benjamin B. Peeler, John A. Kern, Irving L. Kron, Gorav Ailawadi; Surgery, University of Virginia, Charlottesville, VA
Methods: Between January 1996 and December 2007, 1603 patients undergoing elective AVR were entered prospectively into our clinical database. Patients were divided into three eras: I: 1996-1999, II: 2000-2003, III: 2004-2000. A total of 191 patients (12% [191/1603]) had previous sternotomy for CABG (n=88), CABG with AVR (n=16), AVR with or without other aortic procedure (n=30) and other cardiac procedures (n=17). The mean age was 66.5±13.1 years in reoperative AVR patients and 65.5±12.0 years in primary AVR patients. Results: The mortality for reoperative AVR patients significantly decreased over time (I: 15% [6/39], II: 15% [8/53], III: 2% [2/99], p=0.005) and was equivalent to primary AVR in the current era (3.5% [19/542] vs. 2.0% [2/99], p=0.65). Major complication rates also significantly decreased over time in reoperative AVR patients (I: 15% [6/39], II: 17% [9/53], III: 5% [5/99], p=0.04) and was similar to patients undergoing primary AVR (12% [23/191] vs. 15% [215/1412], p=0.30) in the current era. Importantly, patients had more comorbidities including dyslipidemia (26% [10/39], 42% [22/53], 77% [76/99], P<0.0001), coronary artery disease (31% [12/39], 49% [26/53], 84% [83/99], P<0.0001) and hypertension (39% [15/39], 53% [28/53], 69% [68/99], P=0.003) over time while other preoperative risk factors were similar. In reoperative AVR patients, there were no differences in outcome based on primary operation. Specifically, mortality at reoperation was similar following primary CABG + AVR (19% [3/16]), CABG (6% [5/88]) and AVR (9% [6/70], p=0.18). Major complication rates were also not dependent on primary operation (CABG + AVR: 25% [4/16], CABG: 15% [13/88], and AVR: 9% [6/70], p=0.21). Conclusion: Reoperative AVR now carries similar morbidity and mortality as primary AVR. The risk of reoperation is not affected by the primary operation.
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