Lessons from reoperations for mitral stenosis after mitral valve repair.

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Valvular Heart Disease

Background:

• Mitral valve repair (MVr) durability is typically assessed by the absence of recurrent mitral regurgitation.
• Postrepair mitral stenosis (MS) is an infrequent but significant mode of MVr failure.
• This study investigates the mechanisms, surgical strategies, and outcomes of reoperation for postrepair MS.

Purpose of the Study:

• To characterize the mechanisms leading to mitral stenosis after mitral valve repair.
• To summarize reoperative surgical strategies for postrepair mitral stenosis.
• To report mid-term outcomes of patients undergoing reoperation for postrepair mitral stenosis.

Main Methods:

• Retrospective analysis of a prospective database.
• Inclusion of 35 consecutive patients undergoing reoperation for symptomatic moderate to severe MS (January 2011 - February 2020).
• Detailed review of initial repair techniques, reoperative procedures, and follow-up data.

Main Results:

• The primary cause of MS at reoperation was pannus ingrowth (57%), followed by leaflet calcification (34%).
• Smaller initial annuloplasty ring sizes (median 28 mm) were frequently observed.
• Reoperation involved valve replacement in 63% and valve re-repair in 37% of patients, with no in-hospital or 1-year mortality and 5-year survival of 93.9%.

Conclusions:

• Late mitral stenosis after MVr is often associated with smaller annuloplasty ring sizes and inflammatory or calcific valve changes.
• Mitral valve re-repair can be a viable option for highly selected patients.
• Reoperation for postrepair MS demonstrates favorable mid-term survival outcomes.