BACKGROUND: Reoperations after mitral valve repair (MVR) using chordal replacement and annuloplasty for degenerative mitral regurgitation (DMR) and mechanisms of repair failure were analyzed.
METHODS: All patients receiving reoperation after isolated MVR using solely chordal replacement and annuloplasty for DMR between 2003 and 2010 at a high-volume mitral valve center were reviewed. Mechanisms of repair failure were technical failure, disease progression and endocarditis. Technical failure included rupture of neochords and dislocation or breakage of annuloplasty rings. Disease progression was defined as re-prolapse of the repaired leaflet, new prolapse or restriction of leaflets, and rupture of native chordae tendineae. This study aims to investigate reoperations and mechanisms of failure.
RESULTS: Between 2003 and 2010, a total of 344 patients received MVR with solely chordal replacement and annuloplasty. In 72.7% operation was performed via right lateral mini-thoracotomy. Endocarditis and a second cardiopulmonary bypass run at the index operation were identified as independent risk factors for reoperation. After a mean of 6.8 years (0.00 - 14.1 years), 38 (11.0%) patients received reoperation on the mitral valve. The reasons for failure of MVR were disease progression (44.7%), technical failure (31.6%) and endocarditis (18.4%). Re-MVR was performed in 28.9% and was mainly accomplished using redo annuloplasty (90.9%), chordal replacement (90.9%), resection techniques (27.3%) and commissure closure (18.2%). Mitral valve replacement was necessary in 63.2%. One patient (2.6%) received clipping of the repaired mitral valve. In 2 cases the method of reoperation is unknown. Reoperation was performed via median sternotomy in 92.1% and via redo right lateral mini-thoracotomy in 2.6%. In 41.7% associated procedures were performed, e.g. tricuspid valve operation (27.8%) and maze (13.9%). The 30-day mortality rate was 2.6% and overall mortality was 5.3%. Re-reoperation was necessary in 3/24 cases after mitral valve replacement and in 3/11 cases after re-MVR after a median of 3.8 (0.01 - 10.04) years.
CONCLUSIONS: Progression of disease was the main reason for reoperation after MVR using chordal replacement, followed by technical failure. MVR using chordal replacement allows a variety of methods for re-repair including transcatheter solutions.
