PRONOSTIC DES REINTERVENTION POUR DYSFONCTION DE BIOPROTHESE

Between 1969 and 1990, 75 adults living in mainland France underwent reoperation for bioprosthetic valve dysfunction. The average time between the initial operation and reoperation was 65 ± 41 months. The average age was 44 years and half of the patients were severely symptomatic (NYHA Stages III or IV in half the cases). Dysfunction of an aortic valve prosthesis was observed in 65% of cases (N = 49) and of a mitral valve prosthesis in 35% of cases (N = 26). The causes of reoperation were: 50 primary degenerations (67%), 19 infectious endocarditis (25%) and 6 perivalvular leaks (8%). Valve replacement was performed in 74 cases and suture of the sewing ring in 1 case. An associated procedure was performed in 24 cases: 12 drainage of abscess, 10 double valve replacements and 2 tricuspid valvuloplasties. The operative mortality was 9.3% and early morbidity was 46%. Univariate and multivariate analysis identified two factors predictive of operative mortality: the duration of cardiopulmonary bypass and the cardiothoracic ratio. During follow-up, which lasted 36 ± 31 months, there were 12 deaths, 4 of cardiac failure; 4 sudden deaths, 3 deaths related to the prosthesis and 1 extracardiac death. The 6 year actuarial survival rate was 71%. The cardiothoracic ratio, the preoperative ejection fraction and the bypass time were factors predictive of global showed bypass time and the cardiothoracic ratio to be prognostic factors. The 6 year survival without cardiac events was 40%. At the time of publication, the percentage of patients without prosthetic valve dysfunction, reoperation, cardiac failure, haemorrhagic complications, endocarditis or thromboembolism were respectively 81%, 91%, 92.5%, 96%, 98% and 100%. At the end of the follow-up, 93% of patients were in NYHA Stages I or II and 7% in Stages III or IV. In cases of bioprosthetic valve dysfunction, the surgical indication should not be postponed unduly as myocardial dysfunction worsens the prognosis. These results should be taken into consideration in the choice of valve prothesis.