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Thoralf M. Sundt, III
Kenton J. Zehr
Joseph A. Dearani
Richard C. Daly
Charles J. Mullany
Christopher G. A. McGregor
Francisco J. Puga
Hartzell V. Schaff
Thomas A. Orszulak
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Right arrow Valve disease

Ann Thorac Surg 2004;78:67-72
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Risk of repeat mitral valve replacement for failed mitral valve prostheses

D. Dean Potter, MDa, Thoralf M. Sundt, III, MDa*, Kenton J. Zehr, MDa, Joseph A. Dearani, MDa, Richard C. Daly, MDa, Charles J. Mullany, MDa, Christopher G. A. McGregor, MDa, Francisco J. Puga, MDa, Hartzell V. Schaff, MDa, Thomas A. Orszulak, MDa

a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA

Accepted for publication February 3, 2004.

* Address reprint requests to Dr Sundt, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
e-mail: sundt.thoralf{at}mayo.edu

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: Advances in tissue prosthetic valve design and manufacturing have stimulated renewed interest in the use of biological valves in younger patients. This approach, however, risks reoperation. We therefore reviewed our recent experience with repeat mitral valve replacement to better define its contemporary risks.

METHODS: Using a computerized database, we identified and compared 106 patients undergoing repeat mitral valve replacement with 562 control patients undergoing primary mitral valve replacement between January 1993 and December 2000 at our institution.

RESULTS: There were no significant differences between repeat and primary surgery groups with respect to age (mean 66 ± 12 vs 64 ± 13 years), gender distribution (women 65% vs 64%), preoperative functional class, ejection fraction, or active endocarditis (6.6% vs 3.4%). The indication for reoperation in the repeat group was structural dysfunction in 49 patients (46%), paravalvular leak in 21 patients (20%), nonstructural dysfunction in 11 patients (10%), and progression of other native valve disease in 8 patients (8%). Prior prostheses were mechanical in 46 patients (43%). Mean time to reoperation was 11.5 ± 7.1 years. There were 5 deaths out of 106 patients in the repeat group (4.7%) and there were 23 deaths out of 562 patients in the control group (4.1%) (p = NS). Multivariate analysis identified prior myocardial infarction (p = 0.014, odds ratio 2.9) and nonelective surgical status (p = 0.004, odds ratio 2.3) as significant predictors of operative mortality.

CONCLUSIONS: The risk of repeat mitral valve replacement was low suggesting that there should be less reluctance to recommend patients choose a bioprosthesis over a mechanical prosthesis. Given the expected durability of current designs, bioprosthetic use may be explored in younger patients without subjecting those individuals to excessive risk.




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