Late posterior failure after mitral valve repair in degenerative disease.
OBJECTIVE
Little is known regarding the mechanisms, the feasibility and the long-term results of re-repair in 'posterior failure' of a previous mitral valve repair performed for severe degenerative mitral regurgitation. We report our 16-year experience in redo surgery for late posterior failure of mitral valve repair in degenerative disease.


METHODS
From 1991 to 2004, 13 consecutive patients (10 males; median age: 65 years) were reoperated for late posterior failure of mitral valve repair. All patients had grade > or =3+ mitral regurgitation. Repair was mainly performed using Carpentier's techniques.


RESULTS
Repair failure was due to posterior leaflet prolapse, leaflet retraction or leaflet dehiscence in eight (62%), three (23%) and two (15%) patients, respectively. Repair was performed in nine patients (69%). There was no perioperative death. During follow-up (median: 105 months; range: 40-170 months) one late death occurred in the mitral valve replacement group. One (11%) patient underwent mechanical mitral valve replacement 125 months after re-repair. Congestive heart failure occurred in one patient in each group. At the latest follow-up, all but one patient in the mitral valve repair group were in NYHA functional class I or II and all were in sinus rhythm. Doppler echocardiographic studies of the re-repaired valves (n=8) showed no or trivial, grade 1+ and grade 2+ residual mitral regurgitation in 6 (75%), 1 and 1 patients, respectively. Mean transmitral gradient was 3 mmHg (2-8 mmHg) and left ventricular ejection fraction was 59% (43-77%).


CONCLUSIONS
In case of late posterior failure of mitral valve repair for severe degenerative, re-repair is feasible in about 70% of the patients with encouraging results at 10 years.
Zegdi
Rachid
R
Assistance Publique-Hôpitaux de Paris, AP-HP, Service de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France. rzegdi@hotmail.com
Sleilaty
Ghassan
G
Khabbaz
Ziad
Z
Noghin
Milena
M
Latrémouille
Christian
C
Carpentier
Alain
A
Deloche
Alain
A
Fabiani
Jean-Noël
JN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome