Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

Ilaria Giambuzzi*, Giorgia Bonalumi, Giulia Ballan, Pietro Messi, Alice Bonomi, Analia Maggiore, Giampiero Esposito, Michele Di Mauro, Francesco Alamanni, Marco Zanobini

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Redo surgeries are becoming more common because of an increased rate of bioprosthesis implantation. We performed a retrospective study on patients who underwent redo replacement of an aortic and/or mitral bioprosthesis between 2005 and 2018 to evaluate intra-hospital mortality and morbidity. Univariate analysis was performed on the propensity score variables to determine predictors of mortality. A total of 180 patients were enrolled in the study: Group A (replacement of aortic bioprosthesis) with 136 patients (75.56%) and group B (replacement of mitral bioprosthesis ± aortic bioprosthesis) with 44 patients (24.44%). NYHA class ≥ 3 and female sex were significantly more common in group B. Cardiopulmonary-bypass time and aortic cross-clamping time in group A and group B were, respectively, 154.95 ± 74.35 and 190.25 ± 77.44 (p = 0.0005) and 115.99 ± 53.54 and 144.91 ± 52.53 (p = 0.0004). Overall mortality was 8.89%. After propensity score adjustment, Group B was confirmed to have an increased risk of death (OR 3.32 CI 95% 1.02-10.88 p < 0.0001), gastrointestinal complications (OR 7.784 CI 95% 1.005-60.282 p < 0.0002) and pulmonary complications (OR 2.381 CI 95% 1.038-5.46 p < 0.0001). At the univariate analysis, endocarditis, cardiopulmonary-bypass and aortic cross clamping time, NYHA class ≥ 3 and urgency setting were significantly associated to death. Intra-hospital outcomes were acceptable regarding mortality and complications. Patients who need redo surgery on mitral bioprosthesis have an increased risk of post-operative pulmonary and gastrointestinal complications and mortality. Therefore the choice of mitral bioprosthesis at time of first surgery should be carefully evaluated.

Original languageEnglish
Article number7104
Number of pages8
JournalJournal of Clinical Medicine
Volume11
Issue number23
DOIs
Publication statusPublished - 30 Nov 2022

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