Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience.
BACKGROUND
The purpose of this study was to report our 19-year experience in redo surgery for failure of mitral valve repair (MVRep) in degenerative disease.


METHODS
From 1987 to 2006, 43 consecutive patients (32 males) underwent either redo MVRep (n = 21) or redo mitral valve replacement (n = 22) for failure of MVRep. Age ranged from 10 to 78 years (median, 59 years). Forty-one patients (95%) had grade 3+ or greater mitral regurgitation, and 3 patients had chronic systolic anterior motion of the anterior leaflet of the mitral valve. Repair was mainly performed using Carpentier's techniques.


RESULTS
There was no perioperative death in the MVRep group and 2 deaths in the redo mitral valve replacement group. In univariate analysis, long-term survival was significantly superior in the MVRep group compared with redo mitral valve replacement (p = 0.011). There were three reoperations (14%) in the MVRep group for recurrent severe mitral regurgitation. One patient (5%) in the redo mitral valve replacement group underwent reoperation for prosthetic endocarditis. The 7-year freedom from reoperation rate was 95% (95% confidence interval, 84% to 99%) in both groups. At the latest follow-up, 16 (94%) patients in the MVRep group were in New York Heart Association I or II functional status. Fifteen (88%) had no or mild mitral regurgitation on echocardiography. Two patients (12%) presented with moderate (2+) mitral regurgitation.


CONCLUSIONS
In case of failure of MVRep for severe degenerative mitral valve disease, re-repair is feasible in about 50% of the patients with encouraging results at 7 years.
Zegdi
Rachid
R
AP-HP, Assistance Publique-Hôpitaux de Paris, Service de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France. rzegdi@hotmail.com
Sleilaty
Ghassan
G
Latrémouille
Christian
C
Berrebi
Alain
A
Carpentier
Alain
A
Deloche
Alain
A
Fabiani
Jean-Noël
JN
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000601:surgery; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D014463:Ultrasonography