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Methods: A departmental database identified all patients who have undergone two or more consecutive bio-prosthetic aortic valve replacements (AVR). Demographic, preoperative and postoperative data was collected.

Results: 302 patients fulfilled inclusion criteria. Mean follow-up was 18.1 years (max-43). Kaplan-Meier survival analysis shows reduced survival compared to an age/sex matched healthy sample (p<. 001). Cox regression hazard model found the following factors correlated with increased hazard of second BV failure (death attributed to second valve or third AVR); calcific stenosis at first operation, stenotic lesion at second operation, male sex, Ross procedure or xenograft at first operation, Maori/Pacific ethnicity or re-exploration after second operation. Patients experiencing second BV failure were significantly younger, had lower BMI, less likely to have other cardiac disease, had more severe …