TY - CHAP M1 - Book, Section TI - Reoperative Valve Surgery A1 - Ejiofor, Julius I. A1 - Byrne, John G. A1 - Leacche, Marzia A2 - Cohn, Lawrence H. A2 - Adams, David H. Y1 - 2017 N1 - T2 - Cardiac Surgery in the Adult, 5e AB - The number of patients undergoing reoperation for valvular heart disease is increasing and will continue to increase as the general population ages.1 These reoperations most commonly involve structural deterioration of a bioprosthesis or progression of native-valve disease after nonvalve cardiac surgery. Structural failure of a biologic valve should be considered a part of the natural evolution of tissue valves and should be fully appreciated by both the surgeon and the patient prior to implantation.2 Reoperations are technically more difficult than primary operations because of adhesions around the heart with an associated risk of reentry, the presence of more advanced cardiac pathology, and the existence of more frequent comorbidities such as pulmonary hypertension. Perhaps most importantly, reoperative valve replacement operations often are performed in functionally compromised patients who tolerate complications poorly or who have little reserve.3 As a consequence of these and other factors, reoperative valve surgery historically has been associated with a considerably higher operative mortality than primary valve surgery, particularly in patients who have had multiple prior replacements.4 In the modern era, however, with the use of alternative surgical approaches and advanced perioperative care, there has been significant improvement in outcomes.5-9 SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesscardiology.mhmedical.com/content.aspx?aid=1144166138 ER -