title: Reoperation for failure of mitral valve repair.
abstract: OBJECTIVE
  Mitral valve repair is the procedure of choice to correct mitral regurgitation of all types. Up to 10% of patients who undergo mitral valvuloplasty require late reoperation for recurrent mitral valve dysfunction. To determine the causes of failed mitral valve repair, we examined the surgical pathology of patients who underwent reoperation for failed mitral valve repair.
  
  
  RESULTS
  From 1986 to 1994, 81 patients had 86 reoperations for recurrent mitral regurgitation after mitral valve repair. Mean age was 59.2 +/- 1.4 years; 55 were men. Primary valve disease was degenerative in 48 patients (59%), rheumatic in 16 (20%), ischemic in 13 (16%), endocarditic in 3 (4%), and congenital in 1 (1%). Mean time interval between initial mitral valve repair and reoperation was 15.6 +/- 2.5 months. Causes of repair failure were procedure-related (50 cases, 58%), valve-related (33 cases, 38%), or unknown (3 cases, 3%). Procedure-related valve failure was caused by suture dehiscence (21 cases), rupture of previously shortened chordae (19 cases), or incomplete initial correction (10 cases). Valve-related repair failure was caused by progressive primary valve disease (27 cases), endocarditis (5 cases), or extensive leaflet retraction (1 case). Repair failure was procedure-related in 70% of patients with degenerative valvular disease versus only 13% of patients with rheumatic valvular disease (p = 0.0001). At reoperation, mitral valve replacement was performed in 64 patients (79%) and repeat mitral valve repair in 17 (21%).
  
  
  CONCLUSIONS
  We conclude that (1) most mitral valve repair failures are procedure-related in degenerative disease and valve-related in rheumatic disease; (2) rupture of previously shortened chordae is a common cause of late failure in patients with degenerative mitral valve disease; and (3) repeat mitral valve repair results in successful treatment for a minority of patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Gillinov
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: B W
authors.initials: BW
authors.lastname: Lytle
authors.forename: P C
authors.initials: PC
authors.lastname: Taylor
authors.forename: R W
authors.initials: RW
authors.lastname: Stewart
authors.forename: P M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: N G
authors.initials: NG
authors.lastname: Smedira
authors.forename: D D
authors.initials: DD
authors.lastname: Muehrcke
authors.forename: C
authors.initials: C
authors.lastname: Apperson-Hansen
authors.forename: F D
authors.initials: FD
authors.lastname: Loop
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000601:surgery; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure