Redo Versus Primary Minimally Invasive Mitral Valve Surgery: Results From a Multicenter Registry

Redo mitral valve (MV) surgery is associated with increased perioperative risk, mainly related to repeat median sternotomy. Minimally invasive mitral valve surgery (MIMVS) has emerged as an alternative strategy, with excellent results reported in primary procedures; however, its adoption in redo setting remains limited. This study aimed to compare early outcomes of redo vs primary MIMVS in a large multicenter registry.

All consecutive patients undergoing MIMVS between 2015 and 2024 at 7 high-volume centers were retrospectively analyzed. Patients were divided in 2 groups: non-redo patients and patients with at least 1 previous cardiac surgery procedure through median sternotomy. The primary endpoint was perioperative mortality.

Ultimately, 1694 patients were included, 158 (9.3%) had received previous cardiac surgery. Patients undergoing redo surgery presented a significantly higher preoperative risk profile, with higher EuroSCORE II (7.1% vs 1.3%, P < .001) and a greater burden of comorbidities. They were more likely to undergo MV replacement and concomitant tricuspid valve surgery. No significant differences were observed in intraoperative complications. Postoperative outcomes and in-hospital mortality were comparable between groups.

Patients undergoing redo surgery arrive with a significantly higher risk profile when compared with patients undergoing primary MV surgery. Despite this, our analysis on patients undergoing MIMVS shows no differences in terms of perioperative mortality and major complications between groups.