Retrospective Analysis of Outcomes of Cardiac Re-Operations Due to Nonendocarditis-Associated Failure of Heart Valve Prostheses from 2011 to 2025

All articles of this category (opens in new window) Background: With the general increase in life expectancy, re-operations on valve implants are becoming more frequent. These procedures are usually associated with a higher risk than the initial surgery. In the age of TAVI, it is important to know the risks of alternative surgical procedures in order to be able to choose the best possible option for the patients entrusted to us. Methods: We conducted a retrospective analysis of 177 patients undergoing re-operations for nonendocarditis-related prosthetic valve complications at our hospital (2011–2025). We included patients with an aortic and/or mitral prosthetic valve replacement. Pre-, intra-, and postoperative parameters, like demographic data and existing comorbidities, time to redo surgery, as well as position and types of both initial and new prosthesis, cardiopulmonary bypass (CPB), and cross-clamp time (X-time), as well as postoperative complications, were analyzed regarding in-hospital mortality as the primary study endpoint. Group comparisons were performed via Chi 2 , Mann–Whitey U, and t -test. Logistic regression was used to identify independent risk factors. Results: Patients’ mean age was 64 ± 14 years, 62% were male, and 58% were admitted for elective surgery. Median time between initial and redo surgery was 9 years for bio and 15 years for mechanical valves. A congenital heart defect was documented in 7% of the cohort. The exchanges were conducted on the aortic (79%) and mitral valve (19%) or both (2%). Biological to biological replacements predominated (62%). In-hospital mortality was 15%. Univariate analysis revealed significant associations of mortality with coronary heart disease (CHD), reduced left ventricular ejection fraction (LVEF), EuroSCORE II, new prosthesis type (biological), CPB- and X-time, postoperative low cardiac output syndrome (LCOS), re-thoracotomy, and postoperative dialysis/hemofiltration. Multivariate regression confirmed CHD and LCOS as significant independent risk factors for in-hospital mortality. Other cardiovascular variables, prosthesis-related characteristics and postoperative infections such as pulmonary and urinary tract infections or sepsis did not significantly influence patients’ outcome. Conclusion: With the occurrence of CHD and LCOS as independent predictors alongside the 15% in-hospital mortality, this procedure presents a substantial risk, emphasizing the need for tailored decision-making when considering the options of valve replacement. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany