Surgical redo mitral valve replacement in high‐risk patients: The real‐world experience

Abstract

Introduction Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real‐life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. Methods Between March 2012 and November 2020, 58 consecutive high‐risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30‐day and 1‐year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. Results The overall operative, 30‐day, and 1‐year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30‐day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long‐term mortality. Conclusion This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.

Letter to Editor: Surgical redo mitral valve replacement in high‐risk patients: The real‐world experience.J Card Surg. 2021;36(9):3195‐3204

“…We have read with great interest about Zubarevich et al's experience of surgical redo mitral valve replacement in high-risk patients. 1 We also congratulate the authors on the quality of their work, which provides a valuable experience about redo mitral valvuloplasty (MVP) in high-risk patients. They demonstrated with a retrospective study that the overall operative, 30-day, and 1-year mortality in the overall cohort were 3.4%, 22.4%, and 25.9%, respectively, and concluded that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity.…”

Special issues regarding redo mitral valve procedures in the developing countries

“…Therefore, most patients referred for a redo surgery are older and present with multiple comorbidities. 2 With the rapid development of transcatheter mitral valve implantation especially in redo procedures, implantation of mechanical mitral valve prostheses is slowly losing its' popularity in western countries. 3 With the successful broad implementation of anti-infective treatment, rheumatic mitral valve disease has become highly uncommon in the western world.…”

“…The main causes of recurrent mitral valve disease in the western world are degeneration of biological valve prostheses, failed mitral valve repair, dysfunction of mechanical valve prostheses, and infective endocarditis. Therefore, most patients referred for a redo surgery are older and present with multiple comorbidities 2 . With the rapid development of transcatheter mitral valve implantation especially in redo procedures, implantation of mechanical mitral valve prostheses is slowly losing its' popularity in western countries 3 …”

Redo mitral valve replacement for young patients living in low and middle income‐countries: Which prosthesis should I choose?

“…We read with great interest the article from Zubarevich et al 1 describing the risk factors for poor outcomes in high-risk patients undergoing mitral valve replacement (MVR). The authors identified NYHA class IV, infective endocarditis, postoperative dialysis, the high society of thoracic surgeons (STS) score, concomitant procedures, and mechanical prosthesis as risk factors for 30-day and 1-year mortality.…”