Redo mitral valve surgery-a long-term experience.
BACKGROUND
Our experience with reoperative mitral valve (MV) surgery over a 27-year period is presented here.


METHODS
From January 1975 to June 2002, 11,908 operations were performed for MV disease. Out of these 744 were reoperations. The mean age at primary operation was 23.6 +/- 10.1 years (range 2 to 53 years) and at reoperation was 36.0 +/- 11.0 years (range 6 to 65 years) with a mean interval of 11.5 +/- 2.5 years. Mitral valve replacement (MVR) was performed following previous closed mitral valvotomy (CMV) in 408 patients, open mitral commissurotomy (OMC) in 21 patients, and MV repair in 58 patients, MVR in 80 patients, homograft mitral valve replacement (HMVR) in 11 patients. The reasons for reoperation were mainly progression of lesions. Valve thrombosis and endocarditis were indications for reoperation following MVR. Twenty-eight patients underwent redo CMV, 53 patients underwent OMC, and 14 patients underwent MV Repair.


RESULTS
Early mortality was 5.64% (n = 42). Hemorrhage and low cardiac output were the major causes. Follow-up was 124.8 +/- 30.5 months (2 to 300 months). Follow-up was 88%. There were no late deaths in the valve repair group. There were three episodes of thromboembolism in this group (0.3% per patient-year). In the valve replacement group there were six late deaths; three due to valve thrombosis, one due to infective endocarditis, and two due to anticoagulant-related hemorrhage. There were 13 episodes of thromboembolism in this group (0.6% per patient-year).


CONCLUSIONS
Redo MV surgery is safe and can be undertaken with acceptable mortality and morbidity.
Sampath Kumar
Arkalgud
A
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. asampath_kumar@hotmail.com
Dhareshwar
Jayesh
J
Airan
Balram
B
Bhan
Anil
A
Sharma
Rajesh
R
Venugopal
Panangipalli
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000601:surgery*; D016896:Treatment Outcome