Clinical Outcomes of Isolated Redo Mitral Valve Replacement in Patients with Mitral Prosthetic Heart Valve Dysfunction

Abstract

Introduction: Redo mitral valve replacement (redo-MVR) represents a clinical challenge due to higher rates of peri-operative morbidity and mortality.
Patients and Methods: This retrospective study enrolled a total of 103 patients who underwent isolated redo-MVR due to prosthetic valve dysfunction. Patients who had an isolated bypass, low echocardiographic quality, history of repeated re-replacements (more than twice), paravalvular leak repair without preoperative and intraoperative transesophageal echocardiography examination, isolated congenital surgery or isolated open-heart surgical intervention (of any type) without a valve procedure at their first or later operations were excluded. The primary endpoint of the study was in-hospital death. Secondary endpoint included individual morbidity.
Results: A total of 103 patients (mean age: 50.7 ± 13.4 years; male: 58) who underwent isolated redo-MVR were enrolled in this study. The most common complaint of the patients at admission was obstruction or heart failure-related symptoms (80.6%) and the primary indication for redo-MVR was prosthetic valve thrombosis in 58 patients (56.3%). In-hospital mortality was 12.6% (13 patients). The postoperative complications included major bleeding (n= 11) postoperative infection [sepsis, mediastinitis, pneumonia, wound infection (n= 15)], low cardiac output syndrome (n= 10), acute kidney injury (n= 17), pericardial effusion with tamponade (n= 10), pleural effusion requiring hospitalization and drainage (n= 18), ischemic stroke (n= 4), fatal ventricular arrhythmia (n= 1), peripheral embolism (n= 1), moderate to severe paravalvular leak (n= 5). There was not any catastrophic heart laceration.
Conclusion: In-hospital mortality and complications of the isolated redo-MVR in our center are acceptable. With a well-defined protocol and appropriate patient selection, mortality in emergencies cases may be reduced.

This study was approved by Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Institutional Ethics Comittee (2021/12).

Informed consent was obtained.

Externally peer-reviewed.

Concept/Design - AG, EK; Analysis/Interpretation - EK, Tİ, İG; Data Collection - AG, Tİ, ÜA, BO; Writing - AG; Critical Revision - AG, BO, ME, MG; Statistical Analysis - AG, EK; Overall Responsibility - AG, ÜA, İG, BO, EK; Final Approval - All of Authors.

The authors have no conflicts of interest to declare.

The authors declared that this study has received no financial support.