Bioprosthetic replacement after bioprosthesis failure: a hazardous choice?

Abstract Background . Following bioprosthetic failure, replacement is usually done with mechanical valves to avoid repeated reoperations. Methods . From 1986 to 1996 we operated on 130 patients with bioprosthetic failure, implanting a new bioprosthesis; this group included patients with contraindication to anticoagulation, tricuspid replacement, and specific patient requests. Mean age was 63 ± 8 years. Results . The perioperative mortality was 13.8%. At 10 year follow-up the actuarial estimate of survival was 77.4% ± 6.6%. Freedom from structural valve deterioration was estimated at 81.8% ± 6.3%. Freedom from a third operation was estimated at 85.5% ± 5.2%. No patient was permanently anticoagulated. Freedom from thromboembolism was estimated at 91.5% ± 4%, and there were no hemorrhages. Freedom from cardiac-related deaths was estimated at 85.7% ± 5%. Conclusions . This group of patients received the first valve between 1976 and 1986; the range of the cumulative follow-up reaches 20 years, and the extended survival compares favorably with survival of mechanical valves.