Surgical redo mitral valve replacement in high-risk patients: The real-world experience.
mitral valve
redo SMVR
redo procedure
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
02
06
2021
received:
17
03
2021
accepted:
07
06
2021
pubmed:
7
7
2021
medline:
12
8
2021
entrez:
6
7
2021
Statut:
ppublish
Résumé
Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real-life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. Between March 2012 and November 2020, 58 consecutive high-risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30-day and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. The overall operative, 30-day, and 1-year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30-day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long-term mortality. This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3195-3204Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. Journal of Cardiac Surgery Published by Wiley Periodicals LLC.
Références
Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS guidelines for the management of valvular. Heart Dis Rev Esp Cardiol. 2017;71(2):110.
Beckmann A, Meyer R, Lewandowski J, Markewitz A, Gummert J. German Heart Surgery Report 2019: the Annual Updated Registry of the German Society foR Thoracic And Cardiovascular Surgery. Thorac Cardiovasc Surg. 202068(4):263-276.
Beckmann A, Funkat A-K, Lewandowski J, et al. German Heart Surgery Report 2015: the annual updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. 2016;64(6):462-474.
Vohra HA, Whistance RN, Roubelakis A, et al. Outcome after redo-mitral valve replacement in adult patients: a 10-year single-centre experience. Interact Cardiovasc Thorac Surg. 2012;14(5):575-579.
Mehaffey HJ, Hawkins RB, Schubert S, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart. 2018; 104(8):652-656.
Kilic A, Acker MA, Gleason TG, et al. Clinical outcomes of mitral valve reoperations in the United States: an analysis of the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2019;107(3):754-759.
Suri RM, Schaff HV, Dearani JA, et al. Recurrent mitral regurgitation after repair: should the mitral valve be re-repaired? J Thorac Cardiovasc Surg. 2006;132(6):1390-1397.
Anyanwu AC, Itagaki S, Varghese R, Castillo J, Chikwe J, Adams DH. Re-repair of the mitral valve as a primary strategy for early and late failures of mitral valve repair. Eur J Cardio-Thorac Surg. 2014;45(2):352-358.
Shekar PS, Couper GS, Cohn LH. Mitral valve re-repair. J Heart Valve Dis. 2005 Sep;14(5):583-587.
Dumont E, Gillinov AM, Blackstone EH, et al. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg. 2007;84(2):444-450.
Onorati F, Perrotti A, Reichart D, et al. Surgical factors and complications affecting hospital outcome in redo mitral surgery: insights from a multicentre experience. Eur J cardio-thoracic Surg. 2016;49(5):e127-e133.
Patel NC, Hemli JM, Seetharam K, et al. Reoperative mitral valve surgery via sternotomy or right thoracotomy: a propensity-matched analysis. J Card Surg. 2019;34(10):976-982.
Sengupta A, Yazdchi F, Alexis SL, et al. Reoperative mitral surgery versus transcatheter mitral valve replacement: a systematic review. J Am Heart Assoc. 2021;10:e019854.
Yanagawa B, Lee J, Ouzounian M, et al. Mitral valve prosthesis choice in patients <70 years: a systematic review and meta-analysis of 20 219 patients. J Card Surg. 2020;35(4):818-825.
Tchana-Sato V, Hans G, Frippiat F, et al. Surgical management of Staphylococcus capitis prosthetic valve infective endocarditis: retrospective review of a 10-year single center experience and review of the literature. J Infect Public Health. 2020;13(11):1705-1709.
Easo J, Szczechowicz M, Hölzl P, et al. Stentless root replacement versus tissue valves in infective endocarditis: a propensity-score matched study. Braz J Cardiovasc Surg. 2020.
Zubarevich A, Zhigalov K, Rad AA, et al. Open transcatheter multivalve replacement in degenerated valve prostheses in high-risk patients with endocarditis. Braz J Cardiovasc Surg. 2021.
Borger MA, Yau TM, Rao V, Scully HE, David TE. Reoperative mitral valve replacement: importance of preservation of the subvalvular apparatus. Ann Thorac Surg. 2002;74(5):1482-1487.
Akay TH, Gultekin B, Ozkan S, et al. Mitral valve replacements in redo patients with previous mitral valve procedures: mid-term results and risk factors for survival. J Card Surg. 2008;23(5):415-421.
Sampath Kumar A, Dhareshwar J, Airan B, Bhan A, Sharma R, Venugopal P. Redo mitral valve surgery-a long-term experience. J Card Surg. 2004;19(4):303-307.
Zeng J, He W, Qu Z, Tang Y, Zhou Q, Zhang B. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2014;28(3):674-681.
Ejiofor JI, Hirji SA, Ramirez-Del Val F, et al. Outcomes of repeat mitral valve replacement in patients with prior mitral surgery: A benchmark for transcatheter approaches. J Thorac Cardiovasc Surg. 2018;156(2):619-627.
Ruel M, Chan V, Bédard P, et al. Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age. Circulation. 2007;116(11 Suppl):I294-I300.
Tran A, Ruel M, Chan V. High-risk mitral valve surgery: what is the role of risk calculators? Curr Opin Cardiol. 2014;29(2):123-126.