title: Mitral valve re-repair.
abstract: OBJECTIVE
  Between January 1998 and March 2004, a total of 1,596 mitral valve repairs was performed at the authors' institution. Among these operations, 23 constituted re-repair of previously repaired mitral valves. The cases were analyzed retrospectively to ascertain the etiology of the failed repair, the technical considerations of re-repair, and outcome.
  
  
  RESULTS
  Previous repairs were performed for myxomatous valve disease in 14 of 23 patients. In seven patients recurrence occurred within three months of the original procedure (two as a result of infective endocarditis and five after technical failure). Incorrect annuloplasty ring size or failure to use a ring, resulting in progressive annular dilatation with or without new valvular dysfunction, were the main causes of delayed recurrence of mitral regurgitation (i.e. more than one year after the original repair procedure). Most patients (n = 12) required a new annuloplasty ring and additional repair procedures. Two patients died within the immediate post-operative period, and five died subsequently from non-cardiac causes during a mean follow up period of 24 months. Among the remaining 16 patients, 13 were free from mitral regurgitation at follow up and two required subsequent mitral valve replacement.
  
  
  CONCLUSIONS
  Re-repair of the mitral valve is a technically feasible operation that can be safely performed with good functional results. It is, however, associated with some increase in postoperative morbidity and mortality due to the reoperative setting.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design / Q000295:instrumentation; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome