Luciani Nicola, Nasso Giuseppe, Anselmi Amedeo, Glieca Franco, Gaudino Mario, Girola Fabiana, Piscitelli Mariantonietta, Perisano Mario, Martinelli Lorenzo, Possati Gianfederico
Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Ann Thorac Surg. 2006 Apr;81(4):1279-83. doi: 10.1016/j.athoracsur.2005.11.030.
Repeat heart valve operations have become a quite common procedure. We reviewed our experience with reoperative valvular surgery during a 6-year period to assess the risk factors affecting in-hospital mortality and medium-term survival.
A series of 316 redo procedures performed on a total of 290 patients in the period between 1997 and 2002 at our institution was retrospectively analyzed. Univariate and multivariable analyses were performed.
In-hospital mortality was 3.8%; overall mortality at the end of a 30-month follow-up was 9.3%. We identified advanced New York Heart Association class, advanced age, depressed ejection fraction, emergent or urgent presentation, impairment of renal function, and involvement of tricuspid valve as predictors of mortality. In contrast, duration of cardiopulmonary bypass and multiple valve procedure were not associated with increased short-term risk.
The present study is characterized by particular attention in reducing confounding variables and biases correlated to heterogeneities. The main determinants of mortality are related to the degree of patients' illness rather than to inherent technical factors of reoperations. Although highest-risk individuals (previous coronary artery bypass grafting or coexistence of aortic aneurysm) were excluded from the study, our data suggest that patients undergoing isolated redo valvular procedures now face operative risks that are comparable to primary intervention.
再次心脏瓣膜手术已成为一种相当常见的手术。我们回顾了6年间再次瓣膜手术的经验，以评估影响住院死亡率和中期生存率的危险因素。
回顾性分析了1997年至2002年期间在我院对290例患者进行的316例再次手术。进行了单因素和多因素分析。
住院死亡率为3.8%；30个月随访结束时的总死亡率为9.3%。我们确定纽约心脏协会心功能分级晚期、高龄、射血分数降低、急诊或紧急手术、肾功能损害以及三尖瓣受累是死亡率的预测因素。相比之下，体外循环时间和多瓣膜手术与短期风险增加无关。
本研究的特点是特别关注减少与异质性相关的混杂变量和偏倚。死亡率的主要决定因素与患者的病情严重程度有关，而非再次手术本身的技术因素。尽管本研究排除了最高风险个体（既往冠状动脉搭桥术或合并主动脉瘤），但我们的数据表明，单纯再次瓣膜手术患者目前面临的手术风险与初次手术相当。
