Left ventricular function and valvular reoperations.

Between 1961 and 1994, 1,120 adult and adolescent patients had reintervention on the aortic, mitral or both valves. Operative mortality was 7%; five, 10, 15 and 20 year survival rates were 81%, 65%, 54% and 52%, respectively. From the sixties to the nineties, the number of procedures (58 to 304), the age of patients (40 to 57 years), incidence of acute endocarditis (0 to 9%), concomitant coronary surgery (0 to 13%) and the number of repeated interventions (5% to 22%) gradually increased. Despite such increasingly difficult conditions the operative mortality remained low and five-year survival acceptable during the last 20 years. Operative mortality was significantly higher in patients over 65 years (11% vs. 5%), in cases with additional coronary surgery (16% vs. 5%) or interventions on the ascending aorta (17.5% vs. 5%). Left ventricular systolic function was quantitatively assessed before reoperation in 372 patients. In patients with stenotic mitral lesion or with aortic valvular lesion and additional surgical interventions reduced ejection fraction (< 50%) had no effect on late outcome. In regurgitant aortic and mitral lesions and interventions on both valves, there was a trend for less successful late outcome after reintervention, but the difference did not reach statistical significance. It is concluded that valvular reoperations can be performed nowadays with only slightly increased operative risk and an acceptable late outcome as compared to primary valvular operations. Hemodynamically significant valvular and/or prosthetic lesion should be corrected again without delay regardless of an impaired left ventricular function.