Outcomes of Patients Undergoing Mitral Valve Replacement After Failed Attempt at Mitral Valve Repair

Mitral valve repair (MVr) is the ideal treatment strategy for degenerative mitral regurgitation. Mitral valve replacement (MVR) may be required if MVr is unsuccessful during the index surgery. The consequences of MVR following failed MVr during the same surgery are unclear.

Retrospective observational study.

Single institution, university affiliated.

All patients who underwent MVR from 2010 through 2024 were included. Patients with concomitant surgeries were included.

Patients were dichotomized into the intended repair (IR) or de novo replacement (DR) groups based on the intended procedure.

A total of 1,661 patients (mean age, 64 years; 57% female) underwent MVR. MVr was attempted in 133 patients (8%, IR group), and 1,528 underwent planned MVR (92%, DR group). The mean ejection fraction was 55%. Female sex (58.0% in the DR group v 48.9% in the IR group, p = 0.04), history of infective endocarditis (23.8% v 15.0%, p = 0.02), history of cerebrovascular disease (32.1% v 19.5%, p = 0.03), and prior sternotomy (32.1% v 15.8%, p < 0.001) were more prevalent in the DR group. After propensity score matching, perioperative morbidity and mortality were similar. The median cardiopulmonary bypass time and cross-clamp time were longer in the IR group (207 minutes v 134 minutes in the DR group and 163 minutes v 102 minutes in the DR group, respectively). Kaplan-Meier curve analysis showed similar 5-year survival (p = 0.91).

Postoperative outcomes were similar despite longer operative times in the IR group. Failure of initial MVr, leading to MVR, did not translate into adverse early or long-term outcomes. These findings suggest that repair may be more aggressively considered in patients with repairable anatomies.