Bioprosthetic replacement after bioprosthesis failure: a hazardous choice?

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.