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Risk of repeat mitral valve replacement for failed mitral valve prostheses
D Dean Potter1, Thoralf M Sundt, Kenton J Zehr
1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
The Annals of Thoracic Surgery
|June 30, 2004
Summary
Repeat mitral valve replacement carries a low risk, comparable to primary surgery. This suggests bioprosthetic valves may be a viable option for younger patients, even with the possibility of future reoperation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Replacement
- Bioprosthetic Valves
Background:
- Advancements in bioprosthetic valve technology prompt consideration for younger patients.
- Repeat mitral valve replacement is a potential consequence, necessitating risk assessment.
Purpose of the Study:
- To evaluate the contemporary risks associated with repeat mitral valve replacement.
- To compare outcomes of repeat versus primary mitral valve replacement.
Main Methods:
- A retrospective review of 106 patients undergoing repeat mitral valve replacement and 562 undergoing primary mitral valve replacement.
- Data collected from January 1993 to December 2000.
Main Results:
- No significant differences in mortality (4.7% vs 4.1%) or patient demographics between repeat and primary surgery groups.
- Common reoperation indications included structural dysfunction (46%) and paravalvular leak (20%).
- Prior myocardial infarction and nonelective surgery predicted operative mortality.
Conclusions:
- Repeat mitral valve replacement demonstrates a low risk profile.
- Findings support less reluctance in recommending bioprosthetic valves over mechanical valves.
- Bioprosthetic valve use can be considered for younger patients, mitigating excessive risk.