[Operative risk in repeated heart valve replacement].

Eighty three patients aged 7 to 74 years underwent 92 repeat valve replacement procedures on one or more valve prostheses (100 repeated valve replacements). Reoperation was performed for: dysfunction of a mechanical prosthesis (21%), degeneration of a bioprosthesis (13%) progressive prosthetic valve endocarditis (7%), aseptic or sterilised post-endocarditis perivalvular leak (39%), systemic complications (haemolysis or repeated embolism) (20%). Global hospital mortality (30 days) was 12%. Statistical analysis showed three factors were associated with increased operative risk: severe symptoms (Class III or IV) (mortality: 20% compared to 0%, p less than 0,001), emergency reoperation (mortality: 25% compared to 4%, p less than 0,01) and reoperation for a "high risk" indication (dysfunction of a mechanical prosthesis or progressive endocarditis) (mortality: 33% compared to 3%, p less than 0,001). These three factors reflect either the gravity of the complication or the severity of preoperative cardiac failure. On the other hand, when reoperation is carried out at an early stage, mortality is low, the same as that associated with primary valve replacement. The operative risk, therefore, appears to be related to the preoperative cardiac state and not to the technical surgical problems of reoperation. These results underline the necessity of preventing serious acute complications such as acute prosthetic valve thrombosis and endocarditis, and or reoperating chronic complications as soon as possible after diagnosis.