Reoperation after mitral valve repair for degenerative disease

Background. With recent increases in frequency of mitral valve repair for degenerative disease, surgeons will encounter more patients with recurrent mitral regurgitation after repair. Objectives of this study were to determine ( 1) mechanisms for and timing of failed repair of degenerative disease and approach to reoperation, ( 2) durability of re-repair, and ( 3) long-term survival after reoperation. Methods. From January 1980 to January 2005, 188 patients underwent reoperation for recurrent mitral regurgitation. Follow-up averaged 6.5 +/- 5.0 years. Results. Mechanisms of failure were procedure related in 71 patients, valve related in 84, both in 25, or uncertain in 8. Intervention was early ( median, 19 days) for procedure-related failure and later ( median, 5.4 years) for valve-related failure ( p < 0.0001). Procedure-related failure was caused by suture dehiscence in 40 (42%) of 96 patients, rupture of previously shortened chordae in 20 (21%), systolic anterior motion in 20 ( 21%), hemolysis in 21 (22%), and incomplete initial correction in 11 (11%). Valve-related failure was caused by progressive disease in 100 (92%) of 109 patients and endocarditis in 11 (10%); these were not mutually exclusive. Mitral valve replacement was performed in 64% and re-repair in 36% (65% of recent reoperations). Freedom from a second mitral reoperation after re-repair was 93% at 10 years. Survival at 1, 5, and 10 years was 88%, 81%, and 62%, respectively. Conclusions. When reoperation occurs late after repair of degenerative mitral valve disease, new valve pathology is usually the culprit, and re-repair is less common. In contrast, reoperation for procedure-related failure occurs early and is often amenable to re-repair. When performed, valve re-repair is durable.