Recurrent mitral regurgitation after repair: Should the mitral valve be re-repaired?

Rakesh M. Suri, Hartzell V Schaff, Joseph A. Dearani, Thoralf M. Sundt, Richard C. Daly, Charles J. Mullany, Maurice E Sarano, Thomas A. Orszulak

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: We sought to evaluate the clinical and echocardiographic outcomes of reoperation for failed mitral valve repair. Methods: One hundred forty-five patients with recurrent mitral regurgitation after primary mitral valve repair of degenerative leaflet prolapse underwent mitral valve reoperations between January 1, 1970, and January 1, 2005. The mean age was 66 years, and 102 (70%) were men. Results: The mean duration from initial repair to reoperation was 4.1 years (standard deviation = ± 5.1 years). Indications for reoperation were regurgitation alone (n = 109 [75%]), hemolysis (n = 27 [19%]), obstruction from systolic anterior motion (n = 3 [2%]), endocarditis (n = 3 [2%]) and stenosis-other (n = 3 [2%]). New pathology was found in 80 (55%) patients, and failure of the initial repair was found in 61 (42%) patients. The mitral valve was re-repaired in 64 (44%) patients and replaced in 81 (56%) patients. Early operative mortality was similar after re-repair and replacement (1.6% vs 4.9%, P = .38). Independent predictors of improved survival on multivariate analysis were mitral re-repair (hazard ratio = 0.44, P = .03), younger age (hazard ratio = 1.06, P = .001), and an operative indication of mitral regurgitation alone (hazard ratio = 0.31, P = .005). Seven patients had a third mitral operation (all replacements), 6 after re-repair and 1 after replacement. At last follow-up echocardiogram (n = 96), ejection fraction was greater (P < .001) and left ventricular end-systolic dimension was smaller (P = .009) in patients undergoing re-repair compared with values in those undergoing valve replacement. Conclusion: Recurrent mitral regurgitation after prior repair is frequently caused by new valve pathology. Mitral re-repair is performed in almost half of patients and is associated with superior survival, improved ejection fraction, and greater regression in ventricular dimension compared with valve replacement.

Original languageEnglish (US)
Pages (from-to)1390-1397
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume132
Issue number6
DOIs
StatePublished - Dec 2006

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Mitral Valve Insufficiency
Mitral Valve
Reoperation
Pathology
Mitral Valve Prolapse
Survival
Hemolysis
Endocarditis
Pathologic Constriction
Multivariate Analysis
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Recurrent mitral regurgitation after repair : Should the mitral valve be re-repaired? / Suri, Rakesh M.; Schaff, Hartzell V; Dearani, Joseph A.; Sundt, Thoralf M.; Daly, Richard C.; Mullany, Charles J.; Sarano, Maurice E; Orszulak, Thomas A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 132, No. 6, 12.2006, p. 1390-1397.

Research output: Contribution to journalArticle

Suri, Rakesh M. ; Schaff, Hartzell V ; Dearani, Joseph A. ; Sundt, Thoralf M. ; Daly, Richard C. ; Mullany, Charles J. ; Sarano, Maurice E ; Orszulak, Thomas A. / Recurrent mitral regurgitation after repair : Should the mitral valve be re-repaired?. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 132, No. 6. pp. 1390-1397.
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abstract = "Objective: We sought to evaluate the clinical and echocardiographic outcomes of reoperation for failed mitral valve repair. Methods: One hundred forty-five patients with recurrent mitral regurgitation after primary mitral valve repair of degenerative leaflet prolapse underwent mitral valve reoperations between January 1, 1970, and January 1, 2005. The mean age was 66 years, and 102 (70{\%}) were men. Results: The mean duration from initial repair to reoperation was 4.1 years (standard deviation = ± 5.1 years). Indications for reoperation were regurgitation alone (n = 109 [75{\%}]), hemolysis (n = 27 [19{\%}]), obstruction from systolic anterior motion (n = 3 [2{\%}]), endocarditis (n = 3 [2{\%}]) and stenosis-other (n = 3 [2{\%}]). New pathology was found in 80 (55{\%}) patients, and failure of the initial repair was found in 61 (42{\%}) patients. The mitral valve was re-repaired in 64 (44{\%}) patients and replaced in 81 (56{\%}) patients. Early operative mortality was similar after re-repair and replacement (1.6{\%} vs 4.9{\%}, P = .38). Independent predictors of improved survival on multivariate analysis were mitral re-repair (hazard ratio = 0.44, P = .03), younger age (hazard ratio = 1.06, P = .001), and an operative indication of mitral regurgitation alone (hazard ratio = 0.31, P = .005). Seven patients had a third mitral operation (all replacements), 6 after re-repair and 1 after replacement. At last follow-up echocardiogram (n = 96), ejection fraction was greater (P < .001) and left ventricular end-systolic dimension was smaller (P = .009) in patients undergoing re-repair compared with values in those undergoing valve replacement. Conclusion: Recurrent mitral regurgitation after prior repair is frequently caused by new valve pathology. Mitral re-repair is performed in almost half of patients and is associated with superior survival, improved ejection fraction, and greater regression in ventricular dimension compared with valve replacement.",
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T1 - Recurrent mitral regurgitation after repair

T2 - Should the mitral valve be re-repaired?

AU - Suri, Rakesh M.

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Sundt, Thoralf M.

AU - Daly, Richard C.

AU - Mullany, Charles J.

AU - Sarano, Maurice E

AU - Orszulak, Thomas A.

PY - 2006/12

Y1 - 2006/12

N2 - Objective: We sought to evaluate the clinical and echocardiographic outcomes of reoperation for failed mitral valve repair. Methods: One hundred forty-five patients with recurrent mitral regurgitation after primary mitral valve repair of degenerative leaflet prolapse underwent mitral valve reoperations between January 1, 1970, and January 1, 2005. The mean age was 66 years, and 102 (70%) were men. Results: The mean duration from initial repair to reoperation was 4.1 years (standard deviation = ± 5.1 years). Indications for reoperation were regurgitation alone (n = 109 [75%]), hemolysis (n = 27 [19%]), obstruction from systolic anterior motion (n = 3 [2%]), endocarditis (n = 3 [2%]) and stenosis-other (n = 3 [2%]). New pathology was found in 80 (55%) patients, and failure of the initial repair was found in 61 (42%) patients. The mitral valve was re-repaired in 64 (44%) patients and replaced in 81 (56%) patients. Early operative mortality was similar after re-repair and replacement (1.6% vs 4.9%, P = .38). Independent predictors of improved survival on multivariate analysis were mitral re-repair (hazard ratio = 0.44, P = .03), younger age (hazard ratio = 1.06, P = .001), and an operative indication of mitral regurgitation alone (hazard ratio = 0.31, P = .005). Seven patients had a third mitral operation (all replacements), 6 after re-repair and 1 after replacement. At last follow-up echocardiogram (n = 96), ejection fraction was greater (P < .001) and left ventricular end-systolic dimension was smaller (P = .009) in patients undergoing re-repair compared with values in those undergoing valve replacement. Conclusion: Recurrent mitral regurgitation after prior repair is frequently caused by new valve pathology. Mitral re-repair is performed in almost half of patients and is associated with superior survival, improved ejection fraction, and greater regression in ventricular dimension compared with valve replacement.

AB - Objective: We sought to evaluate the clinical and echocardiographic outcomes of reoperation for failed mitral valve repair. Methods: One hundred forty-five patients with recurrent mitral regurgitation after primary mitral valve repair of degenerative leaflet prolapse underwent mitral valve reoperations between January 1, 1970, and January 1, 2005. The mean age was 66 years, and 102 (70%) were men. Results: The mean duration from initial repair to reoperation was 4.1 years (standard deviation = ± 5.1 years). Indications for reoperation were regurgitation alone (n = 109 [75%]), hemolysis (n = 27 [19%]), obstruction from systolic anterior motion (n = 3 [2%]), endocarditis (n = 3 [2%]) and stenosis-other (n = 3 [2%]). New pathology was found in 80 (55%) patients, and failure of the initial repair was found in 61 (42%) patients. The mitral valve was re-repaired in 64 (44%) patients and replaced in 81 (56%) patients. Early operative mortality was similar after re-repair and replacement (1.6% vs 4.9%, P = .38). Independent predictors of improved survival on multivariate analysis were mitral re-repair (hazard ratio = 0.44, P = .03), younger age (hazard ratio = 1.06, P = .001), and an operative indication of mitral regurgitation alone (hazard ratio = 0.31, P = .005). Seven patients had a third mitral operation (all replacements), 6 after re-repair and 1 after replacement. At last follow-up echocardiogram (n = 96), ejection fraction was greater (P < .001) and left ventricular end-systolic dimension was smaller (P = .009) in patients undergoing re-repair compared with values in those undergoing valve replacement. Conclusion: Recurrent mitral regurgitation after prior repair is frequently caused by new valve pathology. Mitral re-repair is performed in almost half of patients and is associated with superior survival, improved ejection fraction, and greater regression in ventricular dimension compared with valve replacement.

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