Reoperation for recurrent cardiac valve disease

AIM:To retrospectively review the experience of valve replacement after closed mitral commissurotomy, valvuloplasty, perivalvular leakage, prosthetic valve obstruction and dysfunction of bioprosthetic valve in 331 patients. METHODS: Three hundred and thirty-one patients (143 males and 188 females) with ages ranging from 12 to 73 years (45.6±12.2 years) with recurrent cardiac valve disease underwent valve replacement. Duration between reoperation and former surgery was 3 months to 25 years (17.3±8.1 years). The reasons for reoperation included mitral valve restenosis after closed mitral commisurotomy (143 cases), valve restenosis and/or insufficiency after mitral or aortic valvuloplasty (53 cases), bioprosthetic valve decline (32 cases), perivalvular leakage (26 cases), other valve diseases after primary valve replacement (21 cases), infective endocarditis after valve replacement, valvuloplasty and repair of ventricular septal defect (24 cases), tricuspid insufficiency after repair of Ebstein’s anomaly (15 cases), prosthetic valve obstruction (9 cases), mitral or tricuspid insufficiency after repair of congenital heart disease (6 cases), and mitral valve restenosis after percutaneous balloon mitral valvuloplasty (2 cases). Reoperations included mitral valve replacement, aortic valve replacement, aortic and mitral valve replacement, tricuspid valve replacement, repair of perivalvular leakage, and valvuloplasty. RESULTS: Four patients died during surgery and 23 patients died during the early postoperative stage. The main causes of early-stage deaths were low cardiac output syndrome, ventricular arrhythmia, multiple organ dysfunction failure, left ventricle rupture, infective endocarditis and renal failure. Three hundred and four patients recovered. Follow-up was performed in 259 patients and duration was from 6 months to 21 years (9.5±6.8 years). NYHA cardiac functional status I to II was found in 189 cases. CONCLUSION: Risk factors for reoperation for heart valve diseases include low preoperative cardiac function, dysfunction failure of important organs, emergency surgery, long-time aortic clamping and cardiopulmonary bypass. Good perioperative management and proper surgical procedures at the appropriate time would produce good results for reoperation for recurrent cardiac valve disease.