Mitral Valve Replacements in Redo Patients with Previous Mitral Valve Procedures: Mid-Term Results and Risk Factors for Survival

Abstract

Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery.

Hospital outcome and predictors of operative mortality in redo MVR adult population

“…Another factor to consider is that some studies had also included patients who previously underwent MV procedures other than replacement (e.g. MV repair and mitral valvuloplasty) [16,19]. In our study, hospitaly mortality was (11.5%) which is concordant with the recent literature [3,5,12], despite the fact that 66.7% of our patients had concomitant procedures.…”

“…In this study, we had not found any correlation between pre-operative and operative variables and prediction of prolonged hospital stay. It is also In some studies, early mortality had been associated with older age [3,5,18], female gender [16], advanced NYHA class [16,19], low left ventricular ejection fraction (<35), increased left ventricular enddiastolic diameter (>50 mm), pulmonary oedema, urgent operations [3,16,12], concomitant procedures [5,19] and previous myocardial infarction [12]. we found that preoperative impairment of the LVEF remains the most consistent risk factor for early and overall mortality following redo-MVR.…”

“…It is important to bear in mind that on the interpretation of the studies reporting hospital mortality for redo valve surgeries that theses do not usually discriminate between the anatomical position of the valve, with results regularly being mixed for aortic, mitral and tricuspid valve replacements [16][17][18]. Another factor to consider is that some studies had also included patients who previously underwent MV procedures other than replacement (e.g.…”

“…We also demonstrated that the LVEF <50% was an independent predictor of operative death in the short-term. Some authors for that reason recommend early intervention before irreversible myocardial damage and/or deteriorating LV function with their inherent surgical risk [16,31]. Prolonged hospital stay is not well described in the studies investigating redo MVR [17,19].…”

The role of gender in coronary surgery

“…Increased rates of valve replacement in females are associated with perioperative left ventricular dysfunction, arrhythmias, and bleeding [57]. Furthermore, the presence of postoperative mitral regurgitation in the setting of ischemic heart disease is more common in women; this increases the risk for postoperative complications and need for readmission, as well as reducing 5-year survival [58].…”