gms | German Medical Science

Background: Redo valve surgery is supposed to be associated with impaired surgical outcome, which particular concerns mitral valve surgery. Therefore data concerning the real surgical risk of redo-mitral valve replacement for non-infectious, isolated mitral disease remain of particluar clinical interest. The present study evaluates the initial and long-term outcomes of isolated mitral redo-surgery and compares the results with first surgery for isolated mitral disease

Materials and methods: A total of 3.450 mitral valve procedures in the time period between 2000 and 2012 were analyzed. The study was restricted to isolated mitral valve procedures; endocarditis was likewise excluded. The study finally included 402 patients undergoing isolated mitral valve surgery, hereby consisting of 102 redo- and 300 first surgeries. Mean patient’s age was 65.2±10.9 years; 58.5% were female; mean logistic EuroSCORE of 10.8±12.1% identified an intermediate risk population

Results: The two groups showed no significant differences in hospital mortality (first: 4.1%; redo: 7.8%; p=0.2710) and no significant differences in long-term survival. Redo procedures demonstrated longer procedure times (197±90min vs. 150±51min; p=0.003, longer ICU-stay >24h (74.5% vs. 43.1%; p=0.001), more bleeding (1311±140ml vs. 591±62ml; p<0.001 and higher need for re-exploration for bleeding (10.3% vs. 2.0%; p=0.04). Further postoperative morbidity differed not significantly (stroke, respiratory failure, renal failure, stroke, myocardial infarction, hospital stay)

Conclusion: Patients needing redo mitral valve surgery are more frequently suffering from relevant comorbidities and thus are affected from nominal higher surgical risk. This higher surgical risk resulted in higher postoperative morbidity, mainly by means of bleeding, re-exploration and prolonged ICU-stay. Nonetheless, primary outcomes -hospital and long-term mortality- differed not significantly. Redo mitral valve surgery can be performed at nearly identical surgical risk compared with first mitral surgery and particularly the results are not limited by surgery itself.