REOPERATION FOR FAILURE OF MITRAL-VALVE REPAIR

Background and Objective: Mitral valve repair is the procedure of choi ce to correct mitral regurgitation of all types, Up to 10% of patients who undergo mitral valvuloplasty require late reoperation for recurre nt mitral valve dysfunction, To determine the causes of failed mitral valve repair, we examined the surgical pathology of patients who under went reoperation for failed mitral valve repair, Patients and Results: From 1986 to 1994, 81 patients had 86 reoperations for recurrent mitr al regurgitation after mitral valve repair, Mean age was 59.2 +/- 1.4 years; 55 were men, Primary valve disease was degenerative in 48 patie nts (59%), rheumatic in 16 (20%), ischemic in 13 (16%), endocarditic i n 3 (4%), and congenital in 1 (1%), Mean time interval between initial mitral valve repair and reoperation was 15.6 +/- 2.5 months, Causes o f repair failure were procedure-related (50 cases, 58%), valve-related (33 cases, 38%), or unknown (3 cases, 3%), Procedure-related valve fa ilure was caused by suture dehiscence (21 cases), rupture of previousl y shortened chordae (19 cases), or incomplete initial correction (10 c ases), Valve-related repair failure was caused by progressive primary valve disease (27 cases), endocarditis (5 cases), or extensive leaflet retraction (I case), Repair failure was procedure-related in 70% of p atients with degenerative valvular disease versus only 13% of patients with rheumatic valvular disease (p = 0.0001), Bt reoperation, mitral valve replacement was performed in 64 patients (79%) and repeat mitral valve repair in 17 (21%), Conclusion: We conclude that (1) most mitra l valve repair failures are procedure-related in degenerative disease and valve-related in rheumatic disease; (2) rupture of previously shor tened chordae is a common cause of late failure in patients with degen erative mitral valve disease; and (3) repeat mitral valve repair resul ts in successful treatment for a minority of patients.