Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation

Abstract

Background:We reviewed our 20-year experience of mitral valve (MV) repair for degenerative mitral regurgitation (MR) and analyzed the mechanisms and risk factors of reoperation. Methods and Results:Six hundred and fifty-four patients who underwent MV repair for degenerative MR between 1991 and 2010 were retrospectively reviewed. The mean follow-up duration was 7.5±4.9 years. Late echocardiography was obtained at a fixed schedule. Standard procedures for MV repair were resection and suture for posterior prolapse, artificial chordal reconstruction for anterior prolapse and a combination of them for prolapse of both. Ring annuloplasty was performed in most cases. We encountered 2 early and 23 late reoperations. Fifteen (60%) were valve-related failure, 9 (36%) were procedure-related failure and 1 was unknown. Valve-related failure was characterized with recurrence of MR due to new prolapse region and progression of mitral stenosis due to leaflet thickening. For them, reoperation was performed at 7.6 years and 14.3 years after the initial operation, respectively. Multivariate analysis identified preoperative left ventricular diastolic diameter and residual regurgitation at discharge as risk factors for reoperation. Conclusions:Valve-related failure occurred late due to slow progression of degenerative disease. Long-term followup after surgery is mandatory. Given that progression and severity of MR were identified as risk factors for reoperation, early surgical intervention is desirable for degenerative MR. (Circ J 2013; 77: 2050 -2055

Outcomes of loop technique with ring annuloplasty: a > 10-year experience

“…In the reoperation group, the patients with mild residual MR before discharge usually had technical issues that affected early-term outcomes. In contrast, the patients who underwent relatively late reoperation because of progression of degenerative changes did not have mild residual MR. Murashita et al [12] also showed that the cause of recurrent MR affected the time of reoperation, indicating that early reoperation was associated with technical issues and that late reoperation was related to progression of degenerative change. In contrast, among patients who had moderate to severe recurrent MR with mild residual MR before discharge without technical issues, few patients had indications for reoperation.…”

Outcomes after mitral valve repair: A single-center 16-year experience

“…In addition, numerous studies demonstrate a persistent failure rate after repair inherently related to the inability of surgery to correct the underlying disease process. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The Brigham and Women's Hospital group reported a 20-year incidence of mitral reoperation of 18%, whereas the Toronto group reported a reoperation rate of only 5.9%. 6 Recurrence of moderate-to-severe MR at 20 years in the latter study was 30.8%, whereas the Mayo clinic group recently reported a 15-year incidence of significant recurrent MR of 13.3%.…”

Structural properties in ruptured mitral chordae tendineae measured by synchrotron-based X-ray phase computed tomography

“…Although mitral valvuloplasty is a well established procedure for MR (Lazam et al, 2017), there have also been reports of recurrent MR requiring repeated mitral valve surgery after an initial mitral valvuloplasty (Nishida et al, 2018;Murashita et al, 2013). In this study, we observed the structural properties of ruptured chorda tendineae by evaluating tissue density.…”

“…However, even when the anatomy of the mitral valve complex inside the heart has been established, the association with the structural properties and the rupturing of chordae tendineae has not been fully investigated. Therefore, there is a possibility of a recurrence of MR following conventional mitral valve repair (Nishida et al, 2018;Murashita et al, 2013).…”