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Late posterior failure after mitral valve repair in degenerative disease

^a Assistance Publique – Hôpitaux de Paris, AP-HP; Service de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Paris, France
^b Université René Descartes, Paris V, France

Received 24 September 2007; received in revised form 27 May 2008; accepted 29 May 2008.

^_* Corresponding author. Address: Hôpital Européen Georges Pompidou, Service de Chirurgie Cardiovasculaire, 20, rue Leblanc, 75908 Paris, France. Tel.: +33 1 56 09 37 48; fax: +33 1 56 09 22 19. (Email: rzegdi{at}hotmail.com).

Objectives: Little is known regarding the mechanisms, the feasibility and the long-term results of re-repair in ‘posterior failure’ of a previous mitral valve repair performed for severe degenerative mitral regurgitation. We report our 16-year experience in redo surgery for late posterior failure of mitral valve repair in degenerative disease. Methods: From 1991 to 2004, 13 consecutive patients (10 males; median age: 65 years) were reoperated for late posterior failure of mitral valve repair. All patients had grade 3+ mitral regurgitation. Repair was mainly performed using Carpentier's techniques. Results: Repair failure was due to posterior leaflet prolapse, leaflet retraction or leaflet dehiscence in eight (62%), three (23%) and two (15%) patients, respectively. Repair was performed in nine patients (69%). There was no perioperative death. During follow-up (median: 105 months; range: 40–170 months) one late death occurred in the mitral valve replacement group. One (11%) patient underwent mechanical mitral valve replacement 125 months after re-repair. Congestive heart failure occurred in one patient in each group. At the latest follow-up, all but one patient in the mitral valve repair group were in NYHA functional class I or II and all were in sinus rhythm. Doppler echocardiographic studies of the re-repaired valves (n = 8) showed no or trivial, grade 1+ and grade 2+ residual mitral regurgitation in 6 (75%), 1 and 1 patients, respectively. Mean transmitral gradient was 3 mmHg (2–8 mmHg) and left ventricular ejection fraction was 59% (43–77%). Conclusion: In case of late posterior failure of mitral valve repair for severe degenerative, re-repair is feasible in about 70% of the patients with encouraging results at 10 years.

Key Words: Heart valve • Mitral valve repair • Surgery