title: Mechanism of and risk factors for reoperation after mitral valve repair for degenerative mitral regurgitation.
abstract: BACKGROUND
  We reviewed our 20-year experience of mitral valve (MV) repair for degenerative mitral regurgitation (MR) and analyzed the mechanisms and risk factors of reoperation.
  
  
  RESULTS
  Six hundred and fifty-four patients who underwent MV repair for degenerative MR between 1991 and 2010 were retrospectively reviewed. The mean follow-up duration was 7.5 ± 4.9 years. Late echocardiography was obtained at a fixed schedule. Standard procedures for MV repair were resection and suture for posterior prolapse, artificial chordal reconstruction for anterior prolapse and a combination of them for prolapse of both. Ring annuloplasty was performed in most cases. We encountered 2 early and 23 late reoperations. Fifteen (60%) were valve-related failure, 9 (36%) were procedure-related failure and 1 was unknown. Valve-related failure was characterized with recurrence of MR due to new prolapse region and progression of mitral stenosis due to leaflet thickening. For them, reoperation was performed at 7.6 years and 14.3 years after the initial operation, respectively. Multivariate analysis identified preoperative left ventricular diastolic diameter and residual regurgitation at discharge as risk factors for reoperation.
  
  
  CONCLUSIONS
  Valve-related failure occurred late due to slow progression of degenerative disease. Long-term follow-up after surgery is mandatory. Given that progression and severity of MR were identified as risk factors for reoperation, early surgical intervention is desirable for degenerative MR.
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. tmurashita@kcho.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Hideo
authors.initials: H
authors.lastname: Kanemitsu
authors.forename: Naoto
authors.initials: N
authors.lastname: Fukunaga
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Konishi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakamura
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Sakon
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Koyama
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011475:Prosthesis Failure / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors