Early and long-term outcomes following redo mitral valve surgery in patients with prior minimally invasive mitral valve surgery

TL;DR

This study examines the outcomes of redo mitral valve surgery in patients who previously had minimally invasive surgery, finding acceptable survival rates and identifying risk factors for long-term mortality.

Contribution

The study provides insights into the safety and outcomes of redo mitral valve surgery following prior minimally invasive approaches.

Findings

Redo mitral valve surgery following prior minimally invasive surgery has a 6.4% 30-day mortality rate.

Preoperative stroke and infective endocarditis are independent predictors of long-term mortality after redo surgery.

Abstract

The frequency of minimally invasive mitral valve surgery (MVS) has steadily increased over the last decades and therefore surgeons are now encountering an increasing number of patients requiring mitral valve (MV) reoperations post-minimally invasive MVS. The aim of this study was to analyse the early postoperative outcomes and the long-term survival in patients who undergo reoperative MVS following previous minimally invasive surgery.

Patients who underwent redo MVS following prior minimally invasive MVS between January 2002 and December 2021 were included in our analysis. Study data were prospectively collected and retrospectively analysed. The primary outcomes were 30-day mortality and long-term survival.

Among the 187 included patients, 34 (18.2%) underwent repeat MV repair and 153 (81.8%) MV replacement. The median age was 66 years (interquartile range 56–74) and 80 (42.8%) patients were female. Redo MVS was performed through median sternotomy in 169 patients (90.4%). A total of 77 (41.2%) patients had additional concomitant procedures. The median intensive care unit stay was 1 day (1–5). The 30-day mortality was 6.4% (12/187). Estimated survival at 5 and 12 years was 61.8% and 38.3%, respectively. Preoperative stroke (hazard ratio 3.28, 95% confidence interval 1.37–7.85, P = 0.007) as well as infective endocarditis (hazard ratio 1.85; 95% confidence interval 1.09-3.11, P = 0.021) were independent predictors of long-term mortality.

Redo MVS following prior minimally invasive MVS can be performed safely with low early perioperative mortality and acceptable long-term survival. Preoperative stroke, infective endocarditis and concomitant tricuspid valve surgery are independent predictors of long-term mortality.

The number of patients requiring reoperative mitral valve surgery (MVS) has increased over the past decades due to more frequent implantation of bioprosthetic valves, the steady increase in prosthetic valve endocarditis, as well as the ageing population [1].

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