Background: Cardiac reoperations are associated with increased morbidity and mortality compared
to first-time surgery. We analyzed our experience with reoperative aortic valve replacement
(Redo-AVR) and compared these results to patients who underwent transapical aortic
valve implantation (TA-AVI) as a second heart operation.
Methods: In this retrospective observational comparative study we analyzed the outcome of
136 patients with prior cardiac surgery who underwent Redo conventional AVR (n = 59;
since 2006) or TA-AVI (n = 77; since 2008) with respect to 30-day outcome (VARC-criteria),
one-year and three-year survival and in order to identify risk factors for both approaches
after previous heart surgery.
Results: Both groups did not significantly differ in their risk profile leading to similar
STS- and EuroSCOREs. 30-day mortality was 3.39% (n = 2) in the Redo-AVR group vs.
7.8% (n = 6) in Redo TA-AVI (p = 0.465). The overall combined safety endpoint at 30
days was significantly lower in TA-AVI patients (18.1% vs. 33.9% in Redo-AVR; p = 0.036).
Unadjusted and adjusted one-year survival showed no difference between compared groups,
unadjusted three-year survival revealed a 2.1 fold higher mortality risk after TA-AVI
(p = 0.055). Adjustment via multivariable Cox regression (HR:1.427;95%CI:0.635;3.209;
p = 0.389) and propensity score HR:1.571;95%CI:0.575,4.291;p = 0.378) led to a more
than 50% risk reduction resulting in a similar three-year survival in the compared
groups.
Conclusion: Redo-AVR can be performed with acceptable results in high-risk patients and still
serves as gold standard. Reoperative valve surgery via TA-AVI is feasible and results
in comparable short- and mid-term survival.