Reoperations for mitral valve disease: Surgical approaches and techniques

Approximately 10% of all adult cardiac operations involve redo thoracotomy, and clinically significant hemorrhage occurs in up to 8% of patients with a resultant increase in operative morbidity and mortality (Ann Thorac Surg 68: 2215-9, 1999). Indeed, in some reports, prior cardiac surgery increases the operative risk of mitral valve (MV) surgery almost twofold (J Am Coll Cardiol 37: 885-92, 2001; J Thorac Cardiovasc Surg 131: 547-57, 2006). Reoperation for MV disease is necessary for a wide variety of problems, such as failure of a previously placed prosthesis, development of a paravalvular leak, endocarditis, or newly diagnosed valve disease in a patient with prior aortic valve replacement or coronary artery bypass. Careful attention to the planning and execution of the operation can minimize surgical risks, and this chapter details those methods that have proved helpful at Mayo Clinic (Rochester, MN)