Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study.

BACKGROUND: Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. METHODS: Among 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR. RESULTS: Hospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 +/- 0.3 vs. 1.6 +/- 0.3 cm(2), p < 0.01). The mean pressure gradient was greater (15.2 +/- 6.4 vs. 12.7 +/- 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 +/- 0.26 vs. 1.06 +/- 0.36 cm(2)/m(2), p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups. CONCLUSIONS: The clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves.