MP71. The Path to Redo Mitral Valve Repair and Outcomes
Presented During: Moderated E-Posters
Yale
New Haven, CT
United States - Contact Me
Alyssa Morrison is a fourth-year medical student at Yale School of Medicine where she is completing a research year under the mentorship of Arnar Geirsson, MD in cardiac surgery focused on surgical outcomes.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: To evaluate the causes and outcomes of redo mitral valve (MV) repair.
Methods: All redo MV repair surgeries performed at a single tertiary academic center from 2013-22 were retrospectively analyzed. The final cohort included 14 patients.
Results: The primary MV repair was performed at a different institution in 7 patients (50%). Etiologies at primary operation were degenerative disease in 11 (78.5%), as well as rheumatic disease (1), trauma (1), and infective endocarditis (1) (Table 1). Mean age at primary repair was 55±16 years. Surgery was performed via sternotomy in 8, mini-thoracotomy in 3, and robotic-assisted in 3. Techniques at primary repair included annuloplasty (n=12), neochordoplasty (n=5), cleft closure (n= 4), and leaflet resection (n=4). Mean size of the annuloplasty ring was 34 ± 1.8 mm. No patient showed greater than mild mitral regurgitation (MR) immediately post-CPB.
The median time from primary repair to recurrent symptoms (or >moderate MR) was 2 years (interquartile range [IQR] 0.5-2.6). The median time from primary repair to redo repair was 2.1 years (IQR 0.8-3). Mean age at re-repair was 58.4 ± 14.9 years. Indications for re-repair were failed repair (n=6) and disease progression (n=8). The median time from primary repair to recurrent symptoms within the subset of failed repairs (n=6) was 0.58 years (IQR 0.08-2.09). Re-repair was performed via sternotomy in 10 and robotic-assisted in 4. Mean cardiopulmonary bypass (CPB) time was 131±53 min and cross-clamp time was 91±53 min. Techniques included redo annuloplasty (n=8), neochordoplasty (n=6), leaflet resection (n=3), and cleft closure (n=5). Concomitant procedures included atrial septal defect closure (n=2), patent foramen ovale closure (n=1), tricuspid valve repair (n=1), and pulmonic valve replacement (n=1).
There were no cases of operative mortality. One patient required reexploration for bleeding and two patients experienced prolonged ventilation. No patients experienced stroke, deep sternal wound infection, or new renal failure. No patients have required a second redo cardiac surgery. Follow up echo data, complete in 85.7% postoperatively at 2.4±2.6 years, indicates that no patients have recurrent greater than moderate MR.
Conclusions: The need for redo MV repair typically arises within the first two years after surgery, particularly for failed repairs. Redo MV repair is a viable option for those with failed prior repair and progression of disease.
Methods: All redo MV repair surgeries performed at a single tertiary academic center from 2013-22 were retrospectively analyzed. The final cohort included 14 patients.
Results: The primary MV repair was performed at a different institution in 7 patients (50%). Etiologies at primary operation were degenerative disease in 11 (78.5%), as well as rheumatic disease (1), trauma (1), and infective endocarditis (1) (Table 1). Mean age at primary repair was 55±16 years. Surgery was performed via sternotomy in 8, mini-thoracotomy in 3, and robotic-assisted in 3. Techniques at primary repair included annuloplasty (n=12), neochordoplasty (n=5), cleft closure (n= 4), and leaflet resection (n=4). Mean size of the annuloplasty ring was 34 ± 1.8 mm. No patient showed greater than mild mitral regurgitation (MR) immediately post-CPB.
The median time from primary repair to recurrent symptoms (or >moderate MR) was 2 years (interquartile range [IQR] 0.5-2.6). The median time from primary repair to redo repair was 2.1 years (IQR 0.8-3). Mean age at re-repair was 58.4 ± 14.9 years. Indications for re-repair were failed repair (n=6) and disease progression (n=8). The median time from primary repair to recurrent symptoms within the subset of failed repairs (n=6) was 0.58 years (IQR 0.08-2.09). Re-repair was performed via sternotomy in 10 and robotic-assisted in 4. Mean cardiopulmonary bypass (CPB) time was 131±53 min and cross-clamp time was 91±53 min. Techniques included redo annuloplasty (n=8), neochordoplasty (n=6), leaflet resection (n=3), and cleft closure (n=5). Concomitant procedures included atrial septal defect closure (n=2), patent foramen ovale closure (n=1), tricuspid valve repair (n=1), and pulmonic valve replacement (n=1).
There were no cases of operative mortality. One patient required reexploration for bleeding and two patients experienced prolonged ventilation. No patients experienced stroke, deep sternal wound infection, or new renal failure. No patients have required a second redo cardiac surgery. Follow up echo data, complete in 85.7% postoperatively at 2.4±2.6 years, indicates that no patients have recurrent greater than moderate MR.
Conclusions: The need for redo MV repair typically arises within the first two years after surgery, particularly for failed repairs. Redo MV repair is a viable option for those with failed prior repair and progression of disease.