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Redo mitral valve surgery following prior mitral valve repair
Author(s) -
Kilic Arman,
Helmers Mark R.,
Han Jason J.,
Kanade Rahul,
Acker Michael A.,
Hargrove Walter Clark,
Atluri Pavan
Publication year - 2018
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13944
Subject(s) - medicine , mitral valve replacement , mitral valve repair , mitral valve , surgery , cardiopulmonary bypass , cardiology , thoracotomy , cardiac surgery , aortic valve replacement , stenosis
Background The optimal treatment strategy following a failed mitral valve repair remains unclear. This study evaluated early and long‐term outcomes of redo mitral valve repair (MVr) and replacement (MVR) after prior mitral valve repair. Methods Patients undergoing redo mitral valve surgery after prior mitral valve repair at a single institution between 2002 and 2014 were reviewed. Primary outcomes included operative mortality (30‐day or in‐hospital mortality) and long‐term freedom from mitral valve reoperation and death. Secondary outcomes included postoperative complications. Results 305 patients underwent redo MVr ( n = 48) or MVR ( n = 257) after prior mitral valve repair. Concomitant procedures included tricuspid valve repair or replacement (23%), aortic valve replacement (6%), and coronary artery bypass grafting (4%), with no differences between cohorts. 18% were performed via right mini‐thoracotomy (24% MVr vs 18% MVR, P = 0.31). Unadjusted and risk‐adjusted operative mortality were lower with MVr (0% vs 8%, P = 0.04). Rates of postoperative complications were similar except for blood product transfusion (35% MVr vs 59% MVR, P = 0.003) and prolonged mechanical ventilation (8% MVr vs 29% MVR, P = 0.003). Long‐term freedom from mortality was comparable: 96% MVr versus 86% MVR at 1 year and 78% MVr versus 68% MVR at 5 years ( P = 0.29). Conclusions When technically feasible, mitral valve re‐repair can be safely performed with outcomes comparable to MVR.