Objectives: Comparison analysis of indications for operation, early clinical outcomes and hospital mortality between patients reoperated for valvular prosthesis dysfunction urgently and electively.
Material and methods: Retrospective data analysis of 94 patients (pts) reoperated for valve prosthesis dysfunction at Department of Cardiovascular Surgery and Transplantology in Kraków, Poland between January 1999 and December 2002.
Results: Valvular reoperation was elective procedure in 69 pts (73.4%)--group A: 46 males (M), 23 females (F), age 23-71 (av. 51.31 +/- 10.2). Urgent operation was performed in 25 pts--group B: 17 M, 8 F, age 29-77 years (av. 5.41 +/- 13.26). In group B: 9 patients underwent reoperation for dysfunction of aortic valve (2 allogenic, 7 mechanical), 13 pts for mitral valve dysfunction and 3 pts for both aortic and mitral valve dysfunction. In group A: 24 pts for mitral valve dysfunction, 37 pts for aortic valve dysfunction (25 allogenic, 12 mechanical) and 8 pts for both aortic and mitral valve dysfunction. In group B: 16 pts (64%) were operated in NYHA class IV; 8 in cardiogenic shock; on which 8 pts with active endocarditis, 3 pts with sepsis and 1 patient in septic shock. Average operative risk calculated as Euroscore was 30.86 in group B and 13.15 in group A (p<0.05). Overall hospital mortality was 12.6% (12 pts). In group B: 7 pts died (28%), 3 pts due to multiorgan failure, 1 patient due to sepsis, 2 pts due to aorta rupture and 1 due to left ventricle rupture during cardiopulmonary rescuscitation. In group B 5 pts died (7.2%).
Conclusion: Patients reoperated urgently for valve prosthesis dysfunction were in worse preoperative state, had significantly higher preoperative risk and in hospital mortality than patients reoperated electively.