Sadeghi Pardis, Hosseinsabet Ali, Mohseni-Badalabadi Reza, Jalali Arash, Vakili-Basir Ahmad, Pashang Mina, Omidi Negar, Bagheri Jamshid, Mehrabanian Mohammadjavad
Cardiology Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Biostatistics, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Med Res. 2025 Apr 17;30(1):305. doi: 10.1186/s40001-025-02563-x.
While previous studies have indicated comparable outcomes for redo surgical valve replacement (SVR) and primary SVR, there is limited information regarding the long-term follow-up of these patients. Providing prognostic data on redo SVR is crucial for enhancing decision-making and medical care, as well as for identifying low-risk subsets of patients eligible for redo SVR. This study aimed to evaluate the short- and mid-term outcomes of patients who underwent their first and second redo SVR of a previously replaced valve.
We included 118 consecutive patients with a history of first or second redo SVR. The participants had a mean age of 57.5 ± 14.4 years, with 71 (60%) being female. The median follow-up period was 69 months. Clinical, intraoperative, and laboratory data were analyzed to assess all-cause mortality, major adverse events (MAE), and a composite of prosthetic valve thrombosis, embolic events, and major hemorrhage (TEH), along with their predictors. Bayesian model averaging was used for statistical analysis.
The 30-day mortality rate was 11 patients (9.3%). Chronic kidney disease was identified as an independent predictor of 30-day mortality. The overall survival rates at one and five years were 86% (95% CI 80% to 93%) and 76% (95% CI 68% to 85%), respectively. Dyslipidemia, a history of major bleeding, chronic kidney disease, stroke, and transvalvular leakage in biological prostheses were all associated with all-cause mortality as independent predictors. The TEH-free survival rates at one and five years were 91% (95% CI 86% to 97%) and 79% (95% CI 71% to 88%), respectively. Diabetes, sex, a history of percutaneous coronary intervention, and baseline functional capacity were identified as independent predictors for the occurrence of TEH. The MAE-free survival rates at one and five years were 82% (95% CI 73% to 92%) and 61% (95% CI 49% to 75%), respectively. Hypertension and baseline functional class were independent predictors of MAE occurrence. The type and anatomical position of the valve were not predictors of mortality, THE, and MAE.
Our study demonstrated acceptable short- and mid-term outcomes for redo SVR, especially in patients without significant risk factors. Several potential predictors of adverse outcomes were identified.
虽然先前的研究表明再次手术瓣膜置换（SVR）和初次SVR的结果相当，但关于这些患者的长期随访信息有限。提供再次手术SVR的预后数据对于改善决策和医疗护理以及识别适合再次手术SVR的低风险患者亚组至关重要。本研究旨在评估接受首次和第二次先前置换瓣膜再次手术SVR患者的短期和中期结果。
我们纳入了118例连续的有首次或第二次再次手术SVR病史的患者。参与者的平均年龄为57.5±14.4岁，其中71例（60%）为女性。中位随访期为69个月。分析临床、术中及实验室数据以评估全因死亡率、主要不良事件（MAE）以及人工瓣膜血栓形成、栓塞事件和大出血（TEH）的综合情况及其预测因素。采用贝叶斯模型平均法进行统计分析。
30天死亡率为11例患者（9.3%）。慢性肾脏病被确定为30天死亡率的独立预测因素。1年和5年的总生存率分别为86%（95%CI 80%至93%）和76%（95%CI 68%至85%）。血脂异常、大出血病史、慢性肾脏病、中风以及生物瓣膜的跨瓣反流均作为独立预测因素与全因死亡率相关。1年和5年无TEH生存率分别为91%（95%CI 86%至97%）和79%（95%CI 71%至88%）。糖尿病、性别、经皮冠状动脉介入治疗史和基线功能状态被确定为TEH发生的独立预测因素。1年和5年无MAE生存率分别为82%（95%CI 73%至92%）和61%（95%CI 49%至75%）。高血压和基线功能分级是MAE发生的独立预测因素。瓣膜的类型和解剖位置不是死亡率、TEH和MAE的预测因素。
我们的研究表明再次手术SVR的短期和中期结果是可接受的，尤其是在没有显著危险因素的患者中。确定了几个不良结局的潜在预测因素。
