REOPERATION AFTER VALVE REPAIR FOR MITRAL REGURGITATION - EARLY AND INTERMEDIATE RESULTS

To better understand late outcomes of mitral valve repair, we reviewed the gases of 49 consecutive patients who underwent reoperation betwee n January 1974 and May 1992 for recurrent valve dysfunction after prev ious valvuloplasty for mitral regurgitation. There were 27 men (55%) a nd 22 women, with a median age of 63 years (range 20 to 84 years). Ori ginal procedures included annuloplasty and posterior leaflet repair in 15 patients (31%), annuloplasty and anterior leaflet repair in 15 (31 %), commissural plication in 13 (27%), and complex bileaflet repairs i n six (12%). Median time between initial mitral repair and reoperation was 2.4 years (range 2 months to 25.3 years). Indications for reopera tion included recurrent severe mitral regurgitation in 34 patients (70 %), hemolytic anemia from mitral regurgitation in seven (14%), mixed m itral regurgitation and stenosis in seven (14%), and isolated mitral s tenosis in one (2%). Before reoperation, 36 patients were in New York Heart Association functional class III and 11 were in class IV. Initia l repairs were intact at the second operation in 32 patients (65%), an d the etiology of recurrent mitral regurgitation in these patients was fibrosis or calcification of the anulus or leaflets in 22 patients, n ewly ruptured chordae in seven, and perforated leaflets in three. The causes of mitral regurgitation in the 17 patients whose initial repair had failed included dehiscence of commissural repairs in nine patient s, dehiscence of ring annuloplasty in four, and breakdown of chordal o r leaflet repair in four. Patients with original repairs involving the anterior leaflet had a significantly shorter time between operations (p = 0.006). In eight patients (16%), the mitral valve was repaired ag ain; in the remaining 41 patients (84%), prosthetic replacement was pe rformed. Operative mortality rate was 4% (two patients). All eight pat ients who underwent mitral valve rerepair had no mitral regurgitation, trivial regurgitation, or mild regurgitation at discharge from the ho spital. Follow-up was 100% complete at a mean of 5.1 years (range 1 to 19 years). Forty-one patients (87%) were in Ne rv York Heart Associat ion functional class I or II, and survival at 5 years was 75.3%. Of th e eight patients who underwent a second repair, seven had no regurgita tion, trivial regurgitation, or mild regurgitation at a median of 4 ye ars' follow-up. The low mortality associated with reoperation supports an aggressive approach toward mitral regurgitation with initial repai r. A second repair can be performed in selected patients with durable results at 4 years.