The risks and benefits of reoperation aortic valve replacement
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The Risks and Benefits of Reoperation Aortic Valve Replacement. Vincent Gaudiani, MD Gary Grunkemeier, PhD Luis Castro, MD Audrey Fisher, MPH YingXing Wu, MD. Objectives. Compare the surgical risks of first time AVR vs. re-operative AVR in 1213 consecutive unselected patients.

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The Risks and Benefits of Reoperation Aortic Valve Replacement

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The risks and benefits of reoperation aortic valve replacement

The Risks and Benefits of Reoperation Aortic Valve Replacement

Vincent Gaudiani, MD

Gary Grunkemeier, PhD

Luis Castro, MD

Audrey Fisher, MPH

YingXing Wu, MD


Objectives

Objectives

  • Compare the surgical risks of first time AVR vs. re-operative AVR in 1213 consecutive unselected patients.

  • Determine the risk factors that predict mortality in this series.

  • Assess the clinical risk of reoperation AVR compared to long term anticoagulation.

The Risks and Benefits of Reoperation Aortic Valve Replacement


Risk of anticoagulation related hemorrhage

Risk of Anticoagulation Related Hemorrhage

  • The composite linearized rate of anticoagulation related hemorrhage in several large series averages 0.9 – 2.5% per year.

    Akins, Ann Thor Surg

    61:806, 1996

The Risks and Benefits of Reoperation Aortic Valve Replacement


Patient demographics

Patient Demographics

The Risks and Benefits of Reoperation Aortic Valve Replacement


The risks and benefits of reoperation aortic valve replacement

Age Histogram: First Operation vs. Reoperation

*

First Op Age Avg = 71

Reop Avg Age = 69

* Statistically significant at p<.05

The Risks and Benefits of Reoperation Aortic Valve Replacement


Prostheses types

Prostheses Types

First Operation (n=887)

Reoperation (n=326)

The Risks and Benefits of Reoperation Aortic Valve Replacement


Prior cardiac operations in reoperative avr s n 326

Prior Cardiac Operations in Reoperative AVR’s (n=326)

The Risks and Benefits of Reoperation Aortic Valve Replacement


Cardiac findings

Cardiac Findings

The Risks and Benefits of Reoperation Aortic Valve Replacement


Coronary disease

Coronary Disease

The Risks and Benefits of Reoperation Aortic Valve Replacement


Concomitant procedures

Concomitant Procedures

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative status

Operative Status

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative times

Operative Times

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative results

Operative Results

The Risks and Benefits of Reoperation Aortic Valve Replacement


Factors predicting mortality by multivariate logistic regression p 0 10

Factors Predicting Mortality by Multivariate Logistic Regression (p<0.10)

  • Factorp-valueOdds Ratio

  • Preop Dialysis 0.004 6.61

  • Preop Cardiogenic Shock 0.001 4.94

  • NYHA Class IV 0.070 1.93

  • Female 0.071 1.85

  • Perfusion Time 0.005 1.11

  • Age 0.023 1.04

The Risks and Benefits of Reoperation Aortic Valve Replacement


Mortality by age group

Mortality by Age Group

The Risks and Benefits of Reoperation Aortic Valve Replacement


Mortality by age group1

Mortality by Age Group

The Risks and Benefits of Reoperation Aortic Valve Replacement


Conclusions

Conclusions

  • The risks of re-operative AVR are low

  • The risks of long-term anticoagulation are known

  • We encourage all adult patients to choose the risks and benefits of tissue vs. mechanical AVR based upon a thorough discussion of these risks

The Risks and Benefits of Reoperation Aortic Valve Replacement


Prosthesis selection

Prosthesis Selection

“ The choice of one type of valve versus the other is largely based on the surgeons’ or cardiologists’ views on what is the least harmful for the patient-anticoagulation for life, or the risk of reoperation.”

Tirone E. David, M.D.

Toronto General Hospital

The Risks and Benefits of Reoperation Aortic Valve Replacement


Patient demographics1

Patient Demographics

The Risks and Benefits of Reoperation Aortic Valve Replacement


Cardiac findings1

Cardiac Findings

The Risks and Benefits of Reoperation Aortic Valve Replacement


Coronary disease1

Coronary Disease

The Risks and Benefits of Reoperation Aortic Valve Replacement


Prior cardiac operations

Prior Cardiac Operations

The Risks and Benefits of Reoperation Aortic Valve Replacement


Concomitant procedures1

Concomitant Procedures

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative status1

Operative Status

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative times1

Operative Times

The Risks and Benefits of Reoperation Aortic Valve Replacement


Operative results1

Operative Results

The Risks and Benefits of Reoperation Aortic Valve Replacement


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