“What Percent of Heart Valve Surgeries Are Re-Operations?” Asks Marc
By Adam Pick on September 14, 2010
I just received a very interesting email from Marc about heart valve surgery re-operations. He writes, “Adam, I’m an active 47 year-old just diagnosed with severe mitral regurgitation. I can’t help but think that I’ll need a 2nd surgery if I get a repair or a tissue valve. Do you know what percent of valve surgeries are re-operations? Are they primarily from surgical error or degenerative reasons? Thanks, Marc”
You can probably understand why I wanted to feature Marc’s email… He asks a great question. Unfortunately, I did not have a great answer. So, I contacted Dr. Kevin Accola, M.D. and Dr. Paul Stelzer, M.D. — two leading heart valve surgeons to learn more about heart valve re-operations.
Dr. Kevin Accola, M.D.
In response to Marc’s question, Dr. Accola, who practices at AdventHealth (formerly Florida Hospital) in Orlando, wrote:
Most institutions with significant volume do between 10% and 15% redo’s on average… Mine is about 12% in regards to patients who have had previous bypass surgery and now need a valve procedure, or a redo valve which has degenerative changes and now needs to be replaced. Sometimes these valves can calcify or the initial degenerative process continues and over time progresses to the point that the valve needs replacement.
Specific to Marc’s question about surgical error, Dr. Accola noted:
Redo’s for “surgical error” is quite low. Although it demonstrates again why a patient should seek out an institution or a surgeon who does a significant volume of valves and has obtained an “experience” with valve repair or replacement. This also demonstrates why we prefer to repair valves earlier as the tissues are typically better with less calcium and more likely repairable.
Dr. Paul Stelzer, M.D.
I then heard from Dr. Stelzer, a heart valve specialist at Mount Sinai Hospital in New York, who shared:
Valve re-operations are very rarely due to “surgical error” but there is definitely a slow degenerative process that affects tissue valves that ultimately leads to re-operation unless the patient is over 70 at initial surgery. As for coming up with a number for what percent of valve operations are re-do cases that is a little hard to estimate. I looked up the New York state data base for the most recent reporting period that has been published (2005-2007). It lists the percentage of valve operations that have had previous open heart surgery as 18.2%. It should be noted that a patient who had previous bypass surgery and then gets a valve operation is included here so it’s not quite the same as a “failed valve” operation. There are also some patients who get endocarditis on a previous aortic valve and have a complete root replacement with a homograft to fix this. These patients are notcounted as valve surgery by the New York state system – the root replacement is considered “other” and these are counted separately with less common operations such as arch replacements, transplants, etc. That’s a bit of a long answer to the question, but the short version would say between 10-15% of operations on valves are reoperations.
For me, these responses were incredibly helpful in learning more about heart valve re-operations. It was also very interesting to see the relative consensus of Dr. Accola and Dr. Stelzer specific to Marc’s inquiry.
Thanks to Marc for his question and thanks to Dr. Accola and Dr. Stelzer for sharing their surgical expertise.
Keep on tickin!