Redo Surgery for Mitral Valve Disease: Is It Really Dangerous?

Objectives: Redo cardiac surgery is associated with significant mortality and morbidity, recent publications report early mortality rates around 10%. Not surprisingly, transcatheter procedures for mitral valve (MV) treatment are on the horizon. The aim of this study is to retrospectively evaluate a single center experience with redo patients for mitral MV disease regarding mortality, and to identify risk factors for adverse outcome.

Methods: A total of 259 patients (124 females, 135 males) underwent redo surgery for MV disease between 2004 and 2020. Previous procedures were mainly isolated valve surgery (69%) and isolated CABG (12%). In 73% MV, incompetence was present, isolated MV stenosis only in 27%. Resternotomy was performed in 90%, a video-assisted lateral thoracotomy was accomplished in 10% of patients without X-clamp.

The MV was replaced in 68% of cases; in 32% the valve was successfully repaired. Concomitant procedures were tricuspid repair (35%), aortic valve replacement (17%), and CABG (16%). Univariate and multivariate analyses (logistic regression) were performed to identify risk factors for mortality.

Result: Early mortality (all in hospital mortality until discharge home and/or 30-day mortality) was 6.9% (n = 18). Univariate analysis identified age, EuroSCORE, creatinine clearance, cross-clamp time, ECC time, ventilation time, need for ECMO support, bleeding requiring surgery, acute kidney failure, and multiorgan failure as significant risk factors. In a multivariate analysis, cross-clamp time (p = 0.04, CI = 0.97–0.99), ECC time (p = 0.004, CI = 1.004–1.022), need for ECMO (p = 0.002, CI = 2.67–69.6), and multiorgan failure (p = 0.01, CI = 1.55–30.4) remained independent risk factors for mortality.

Conclusion: Redo surgery for mitral valve disease carries an acceptable perioperative risk. Typical risk factors are significant in univariate analysis; however, not a single preoperative variable including EuroSCORE is an independent predictor for mortality. Most important risk factors are need for ECMO support and development of multiorgan failure, irrespective of age, gender, lung and kidney function, or the presence of endocarditis. Redo per se can be successfully performed in most patients; selection of patients for interventional treatment is not clear as preoperative factors are not predictive for mortality.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021