Outcomes of reoperative aortic valve surgery: data from a national registry over 23 years.

OBJECTIVE

Over the past two decades, early mortality following re-operative aortic valve surgery has declined significantly; however, it remains higher than that observed after primary isolated valve replacement. We sought to examine temporal trends and identify independent predictors of adverse outcomes in patients undergoing re-operative aortic valve surgery.

METHOD

The study included all patients undergoing re-operative aortic valve replacement (AVR) in the United Kingdom between January-1996 and March-2019 including those with multiple previous operations and those undergoing additional procedures. Data was obtained from the National Institute of Cardiovascular Outcomes Research database. The primary objective was to assess in-hospital mortality trends. Secondary objective was to identify risk factors for in-hospital mortality. Multivariable analysis was carried out to identify independent risk factors for in-hospital mortality.

RESULTS

During the study period, 6,109 re-operative aortic valve surgeries were carried out in the United Kingdom. There were 1,973(32%) females, median age was 69(60-76) years with median duration between the initial and the reoperation being 7(2-13) years. Bio-prosthetic valves were more commonly explanted compared to mechanical valves: 4,125(68%) vs. 1,641(27%). Mortality for elective re-operative cases was 4.8% ( = 166). After adjustments, surgery after 2007, age, number of previous operations, urgency of operation, gender, concomitant procedures, pre-operative chronic kidney disease and endocarditis, were important predictors of outcomes. Mortality showed a downward trend during the study period ( < 0.001).

CONCLUSION

With advances in management strategies, mortality following re-operative AVR continues to decline, but still remains significant. Structural degeneration of bioprosthetic valves continues to be the most common indication for re-operation Emergency re-operations are associated with substantially higher mortality rates; therefore, close follow-up of these patients is essential to facilitate timely elective re-intervention before clinical deterioration.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12055-025-01980-1.