Short- and long-term outcomes following redo valvular
Naoto Fukunaga MD
Ryuzo Sakata MD
Tadaaki Koyama MD
Department of Cardiovascular Surgery, Kobe
City Medical Center General Hospital, Kobe,
Naoto Fukunaga MD, Division of
Cardiovascular Surgery, Toronto General
Hospital, University of Toronto, Peter Munk
Cardiac Centre, 200 Elizabeth Street, Toronto,
ON M5G 2C4, Canada.
Aim: We reviewed our experience in redo valvular surgery to evaluate trends in short-
and long-term outcomes.
Methods: We reviewed 414 patients (mean age, 62.8 ± 13.6 years) who underwent
redo valvular surgery in the past 25 years. A total of 301 patients (54.2%) underwent
first-time redo valvular surgeries; 178 (32.1%) were second redos, 60 (10.8%) were third
redos, and 16 were fourth redos (2.9%). The mean follow-up period was 6.8 ± 6.3 years.
Results: Hospital mortality was 5.8%. New York Heart Association (NYHA) class III/IV
(P = 0.0007, odds ratio = 4.403) and hemodialysis (P = 0.0383, odds ratio = 7.196) were
risk factors for hospital death. Long-term survival rates at 15 and 20 years were
64.7% ± 4.3% and 59.1% ± 5.0%, respectively. Predictors of late death were first time
redo (P = 0.0076, hazard ratio = 0.422) and age younger than 61 years (P = 0.0005,
hazard ratio = 0.229). There were significant differences in long-term survival between
NYHA classes I/II and III/IV (log-rank test, P = 0.0419) and between the time from redo
surgery (log-rank test, P = 0.0189) and age (log-rank test, P = 0.0001).
Conclusions: The hospital mortality rate for redo valve surgery has improved. Early
referral for redo surgery can contribute to improving early and late outcomes.
25 years of experience, redo valvular surgery
There is a trend toward an increase in the number of older patients who
undergo redo valvular surgery. The mortality rate following redo
valvular surgery may exceed 7.0%.
In our previous report describing
outcomes of redo valvular surgery, the mortality rate was 6.7% and
was greater than 7.0% in patients older than 75 years.
Recently, percutaneous valve-in-valve prostheses and sutureless
valves have been used to treat high-risk patients requiring re-operative
This has significantly reduced the short-term mortality in
We reviewed our 25 years of experience with redo
valvular surgery to determine the short- and long-term outcomes of
redo surgery in the emerging era of transcatheter valve replacement.
MATERIALS AND METHODS
This study was approved by institutional review board at Kobe City
Medical Center General Hospital.
We retrospectively reviewed the medical records of 414 patients
(mean age, 62.8 ± 13.6 years: range, 12-88 years) who underwent redo
valvular surgery at our hospital from January 1990 to December 2015.
This study was performed in accordance with the Society of Thoracic
All of the patients underwent one or more valve surgeries.
This study included patients with concomitant procedures
including coronary artery bypass, aortic repair, or arrhythmia surgery.
In 414 patients who received redo surgery, 301 (54.2%) redo
procedures were the first redo, 178 (32.1%) were second redos, 60
ACQUIRED CARDIOVASCULAR DISEASE
© 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jocs J Card Surg. 2018;33:56–63.