ABSTRACT
Bioprosthetic heart valves are increasingly being used in preference to a mechanical valve in younger adult patients, and have been associated with comparable long-term survival.1-6 e major advantage of tissue valves is that there is no need for long-term anticoagulation with its inherent risks of bleeding and thromboembolism.2,3,5,6 However, the trade-o is an increased risk of late reoperation due to structural degeneration, which progressively increases with time.1,3,6,7 Reoperation is the current standard of care for bioprosthetic failure but can be associated with signicant risk, which is escalated further by older age and the concomitant comorbidity oen associated with these patients, such as le ventricular dysfunction, renal insuf-ciency, pulmonary hypertension, and the need for a concurrent cardiac procedure. e operative mortality for an elective redo aortic valve surgery is reported to range from 2% to 7%, but this percentage can increase to more than 30% in high-risk patients.8,9 Furthermore, redo surgery can be associated with signicant morbidity such as blood transfusions, renal failure, wound infection, postoperative pain, and delayed recovery.1,10 As more younger patients are successfully treated with tissue valves and their life expectancy continues to increase, we will be faced with a growing number of degenerated bioprostheses requiring reoperation.11
