Re-repair of the mitral valve as a primary strategy for early and late failures of mitral valve repair

Abstract

With the expanding uptake of mitral valve repair as the primary therapy for mitral valve regurgitation, an increasing cohort of patients are presenting with failures following valve repair. These patients have traditionally been treated by mitral valve replacement. We have adopted an aggressive strategy of valve re-repair for failures of mitral valve repair and present our mid-term results. Fifty-three consecutive adults underwent reoperation by a single surgical team for failed non-rheumatic mitral valve repair. Primary valve repair had been done for degenerative (n = 38), congenital (n = 6), infective (n = 3), functional (n = 1) or unknown (n = 5) mitral disease. The reoperative mitral procedure occurred at a median interval of 3 (interquartile range 0.9–6.5) years from the primary mitral valve repair. Valve re-repair was attempted if the anterior leaflet was sufficiently pliable, and lesions causing recurrence were identifiable and deemed treatable. Standard repair techniques were employed in re-repair procedures. Valve analysis showed that the mode of failure was progression of original disease in 19 (36%), technical failure in 20 (38%) and new disease in 14 (26%) patients. Valve re-repair was successfully accomplished in 45 (85%) patients. Re-repair was most frequent when the prior aetiology was degenerative (34 of 38, 90%) as opposed to non-degenerative (11 of 15, 73%). There were no hospital deaths. Four-year patient survival was 97%. Freedoms from moderate mitral regurgitation were 100, 95, 88 and 80% at discharge and at 1, 3, and 4 years, respectively. There were no reoperations in the follow-up period. Re-repair of the mitral valve is feasible in most of the cases of failed mitral valve repair of non-rheumatic aetiology and has acceptable mid-term outcomes. The relatively high prevalence of technical failures as the mechanism of failure of the primary mitral valve repair suggests the need for ongoing surgical education and continuing development and refinement of repair techniques.