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Contemporary outcomes in reoperative mitral valve surgery
Hunter J Mehaffey1, Robert B Hawkins1, Sarah Schubert1
1Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
Heart (British Cardiac Society)
|October 7, 2017
Summary
Redo mitral valve surgery is increasing and, despite higher initial risks, outcomes have significantly improved over time, now exceeding predictions. This highlights advancements in managing complex cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Surgery
Background:
- Redo mitral valve surgery is becoming more common.
- Previous studies suggest potentially better outcomes for redo procedures.
- Understanding risk factors and outcomes is crucial for patient management.
Purpose of the Study:
- To analyze outcomes of redo mitral valve surgery.
- To identify predictors of poor outcomes in these patients.
- To assess trends in redo mitral valve surgery volume and outcomes.
Main Methods:
- Analysis of 11,973 open mitral valve cases from a regional Society of Thoracic Surgery (STS) database (2002-2016).
- Stratification of patients into primary and redo mitral valve surgery groups.
- Use of mixed-effects logistic regression to identify risk factors for redo surgery.
Main Results:
- Redo mitral valve surgery comprised 9.7% of cases, with increasing volume (10% per year).
- Redo patients had higher rates of valve replacement, comorbidities, complications, and operative mortality (11.1% vs. 6.5%).
- Key risk factors for morbidity/mortality included cardiogenic shock, severe tricuspid insufficiency, urgent status, and concurrent coronary artery bypass grafting. Observed-to-expected mortality ratios improved over time.
Conclusions:
- Redo mitral valve surgery represents a significant and growing proportion of mitral valve operations.
- While associated with increased initial risk and resource use, outcomes have markedly improved and are now better than predicted.
- Continuous monitoring and risk factor analysis are essential for optimizing redo mitral valve surgery results.
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