Abstract 17729: Multiple Reoperations on the Mitral Valve. Results and Risk Factors for Immediate and Long-term Outcomes
Introduction: Operative mortality and long-term outcomes are keystones in the choice of valve substitute and operative strategy in multiple reoperations on the mitral valve (MV). At the dawn of percutaneous valve-in-valve replacement, we sought to specifically evaluate the current outcome of conventional surgery for MV re-interventions.
Methods: From January 2004 to December 2014, a series of 368 consecutive patients underwent an open MV redo-surgery. The operation was a first MV re-intervention in 229 patients (group 1), a second in 84 (group 2), a third in 41 (group 3) and a fourth or more in 14 (group 4). Multivariate analysis was performed to identify predictive factors of outcomes.
Results: Two hundred patients were female (54%), mean age of the study population was 55±17 years and mean preoperative Euroscore II was 9.6±8.0%. The causes for MV re-intervention were: recurrent mitral regurgitation after MV repair in 56% (n=206), prosthetic valve dehiscence in 20.7% (n=76), structural valve deterioration in 11.7 (n=43), endocarditis in 7.6% (n=28) and mechanical valve thrombosis in 3.8% (n=14). There were 86 aortic valve (23.4%) and 166 tricuspid valve (45.1%) associated procedures. Overall 30-day mortality was 13.4% (n=49): 9.6% (n=22) in Group 1, 14.3 %(n=12) in Group 2, 22.0 % (n=9) in Group 3 and 42.8% (n=6) in Group 4. Re-entry injuries to the heart and great vessels were encountered in 18 patients (4.9%) and were considered as fatal in 8 cases (2.2%). Survival at 5 years was 85±2% in Group 1, 77±4% in Group 2, 63±8% in Group 3 and 42±13% in Group 4. Survival at 10 years was 79±4%, 62±7% and 51±10% in Groups 1, 2 and 3, respectively. Freedom from valve reoperation for the entire cohort was 96±1% and 85±3% at 5 and 10 years, respectively. Higher preoperative NYHA class (HR: 2.1 [1.1-4.2], p=0.03) and serum creatinine level (HR: 1.01 [1.00-1.02],p=0.002) were correlated with higher operative mortality and poor long-term prognosis while the number of redo-interventions was not found to be an independent risk factor.
Conclusion: Multiple MV reoperations carry an elevated risk for early mortality and reduced long-term survival but patients’ outcomes are more influenced by their clinical status at presentation rather than by the number of re-sternotomies.
Author Disclosures: J. Jouan: None. L. Du Puymontbrun: None. P. Achouh: None. S. Salvi: None. P. Menasché: None. A. Carpentier: Research Grant; Modest; Edwards Lifescience. Ownership Interest; Significant; Edwards Lifescience.. C. Latremouille: None. J. Fabiani: None.
- © 2016 by American Heart Association, Inc.