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Surgical redo mitral valve replacement in high‐risk patients: The real‐world experience
Author(s) -
Zubarevich Alina,
Szczechowicz Marcin,
Zhigalov Konstantin,
Rad Arian A.,
Vardanyan Robert,
Easo Jerry,
RoostaAzad Mehdy,
Kamler Markus,
Schmack Bastian,
Ruhparwar Arjang,
Wendt Daniel,
Weymann Alexander
Publication year - 2021
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.15787
Subject(s) - medicine , infective endocarditis , concomitant , surgery , endocarditis , mitral valve , mitral valve repair , mitral valve replacement , clinical endpoint , cohort , randomized controlled trial
Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real‐life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. Methods Between March 2012 and November 2020, 58 consecutive high‐risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30‐day and 1‐year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. Results The overall operative, 30‐day, and 1‐year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30‐day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long‐term mortality. Conclusion This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.