The Price of Redo Mitral Valve Replacement: Determinants of Major Adverse Postoperative Events

Background: Redo mitral valve replacement is a high-risk operation in which early mortality alone may underestimate postoperative burden. We evaluated whether concomitant tricuspid valve repair independently increases major adverse postoperative events after redo mitral valve replacement. Methods: Consecutive patients undergoing redo mitral valve replacement between 2019 and 2025 were retrospectively reviewed. Isolated redo mitral valve replacement was compared with redo mitral valve replacement plus concomitant tricuspid valve repair. The primary endpoint was major adverse postoperative events, defined as early mortality, acute kidney injury, cerebrovascular event, prolonged ventilation, reoperation, deep sternal infection, mechanical circulatory support, or permanent pacemaker implantation. Results: The final cohort included 249 patients: 134 underwent isolated redo mitral valve replacement and 115 underwent concomitant tricuspid valve repair. Patients receiving tricuspid valve repair were older, had higher pulmonary artery pressure, and had a longer interval from the previous operation. They also had longer ventilation, longer intensive care unit stay and higher rates of atrial fibrillation, atrioventricular block, and permanent pacemaker implantation. Early mortality was similar between groups. Major adverse postoperative events occurred in 122 patients. Concomitant tricuspid valve repair was not associated with major adverse postoperative events in univariable analysis. In multivariable analysis, concomitant tricuspid valve repair was not independently associated with MAPE. Increasing age, smoking, lower left ventricular ejection fraction, and longer cardiopulmonary bypass time remained independently associated with MAPE. Conclusions: Early major postoperative morbidity after redo mitral valve replacement was associated primarily with patient-related risk factors and operative complexity. Concomitant tricuspid valve repair was not independently associated with MAPE after adjustment for the available covariates.