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Background: Cardiac reoperations are associated with increased morbidity and mortality compared to first-time surgery. We analyzed our experience with reoperative aortic valve replacement (Redo-AVR) to assess the outcome of conventional Redo-AVR and to compare these results to patients who underwent Transapical aortic valve implantation (TA-AVI) as a second heart operation.
Methods: The review of our databases identified 91 patients with prior cardiac surgery who underwent Redo conventional AVR (n=59; since 2006) or TA-AVI (n=32; since 2008). We used the existing data for this retrospective single centre analysis.
Results: Both groups did not significantly differ in their risk profile leading to similar STS-Scores (STS-ROM: Redo-AVR: 17,9±9,9 vs. TA-AVI 20,7±8,1; p=0,174). Overall mortality was 22% (13 patients) in the Redo-AVR group and 37,5% (12 patients) after TA-AVI (p=0,142). Mean survival after Redo-AVR was 25,3±17,4 vs. 11,2±10,3 months in TA-AVI patients (p=0,053). Six-months and 18-months actuarial survival were 84,1±4,9% and 80±5,4% in the Redo-AVR group vs. 77,7±8,1% and 47,5±11,9% in TA-AVI. Multivariable analysis identified preoperative atrial fibrillation (Hazard ratio (HR) 3,12; 95% CI: 1,2-8,2; p=0,021), preoperative renal insufficiency (HR 3,26; 95% CI: 1,21-8,77; p=0,02), postoperative increase of serum creatinine >200% within 48 hours and postoperative pacemaker implantation (HR 4,3; 95% CI: 1,25-14,78, p=0,021) as independent negative predictors of long-term survival.
Conclusion: Conventional Redo-AVR can be performed with acceptable results in this population and still serves as gold standard for Redo-AVR. Reoperative isolated valve surgery via TA-AVI is feasible and results in short- and long-term survival that is comparable to patients after conventional AVR.