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Wagner CM, Fu WW, Brescia AA, Hawkins RB, Romano MA, Ailawadi G, Bolling SF. Repeat crossclamp after failed initial degenerative mitral valve repair is safe and successful. JTCVS OPEN 2023; 16:209-217. [PMID: 38204717 PMCID: PMC10775030 DOI: 10.1016/j.xjon.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 01/12/2024]
Abstract
Objective Surgical risk and long-term outcomes when re-crossclamp is required during degenerative mitral valve repair are unknown. We examined the outcomes of patients who required re-crossclamp for mitral valve reintervention. Methods Adults undergoing mitral valve repair for degenerative mitral valve disease at a single center from 2007 to 2021 who required more than 1 crossclamp for mitral valve reintervention were included. Outcomes including major morbidity and 30-day mortality were collected. Kaplan-Meier analysis characterized survival and freedom from recurrent mitral regurgitation. Results A total of 69 patients required re-crossclamp for mitral valve reintervention. Of those, 72% (n = 50) underwent successful re-repair and the remaining underwent mitral valve replacement (28%, n = 19). Major morbidity occurred in 23% (n = 16). There was no 30-day mortality, and median long-term survival was 10.9 years for those undergoing re-repair and 7.2 years for those undergoing replacement (P = .79). Midterm echocardiography follow-up was available for 67% (33/50) of patients who were successfully re-repaired with a median follow-up of 20 (interquartile range, 7-37) months. At late follow-up, 90% of patients had mild or less mitral regurgitation. Of those re-repaired, 2 patients later required mitral valve reintervention. Conclusions Patients requiring re-crossclamp for residual mitral regurgitation had low perioperative morbidity and no mortality. Most patients underwent successful re-repair (vs mitral valve replacement) with excellent valve function and long-term survival. In the event of unsatisfactory repair at the time of mitral valve repair, attempt at re-repair is safe and successful with the appropriate valvar anatomy.
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Affiliation(s)
- Catherine M. Wagner
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Whitney W. Fu
- Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | | | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Matthew A. Romano
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
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Zhong Z, Xu H, Song W, Liu S. Re-repair vs. Replacement for Failed Mitral Valve Repair: A Systemic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:868980. [PMID: 35774370 PMCID: PMC9237322 DOI: 10.3389/fcvm.2022.868980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe objective of this study was to compare outcomes of re-repair with those of mitral valve replacement (MVR) for failed initial mitral valve repair (MVr).MethodsWe searched the Pubmed, Embase, and Cochrane Library databases for studies that compared mitral valve re-repair with MVR for the treatment of failed initial MVr. Data were extracted by two independent investigators and subjected to a meta-analysis. Odds ratio (OR), risk ratio (RR), hazard ratio (HR), ratio difference (RD), mean difference (MD), and 95% confidence interval (CI) were calculated with the Mantel-Haenszel and inverse-variance methods for mode of repair failure, perioperative outcomes, and follow-up outcomes.ResultsEight retrospective cohort studies were included, with a total of 938 patients, and mean/median follow-up ranged from 1.8 to 8.9 years. Pooled incidence of technical failure was 41% (RD: 0.41; 95% CI: 0.32 to 0.5; P = 0.00; I2 = 86%; 6 studies, 846 patients). Pooled mitral valve re-repair rate was 36% (RD: 0.36; 95% CI: 0.26–0.46; P = 0; I2 = 91%; 8 studies, 938 patients). Pooled data showed significantly lower perioperative mortality (RR: 0.22; 95% CI: 07 to 0.66; I2 = 0%; P = 0.008; 6 studies, 824 patients) and significantly lower long-term mortality (HR:0.42; 95% CI: 0.3 to 0.58; I2 = 0%; P = 0; 7 studies, 903 patients) in the re-repair group compared with MVR.ConclusionsMitral valve re-repair was associated with better immediate and sustained outcomes for failed MVr and should be recommended if technically feasible.
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Veerappan M, Cheekoty P, Sazzad F, Kofidis T. Mitral valve re-repair vs replacement following failed initial repair: a systematic review and meta-analysis. J Cardiothorac Surg 2020; 15:304. [PMID: 33028386 PMCID: PMC7542900 DOI: 10.1186/s13019-020-01344-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background The optimal treatment strategy following a failed mitral valve repair remains unclear. This study aims to compare and analyse available studies which report the clinical outcomes post mitral valve re-repair (MVr) or replacement (MVR) after a prior mitral valve repair. Methods Based on PRISMA guidelines, a literature search was performed utilising PubMed, Cochrane and Scopus databases to identify retrospective cohort studies that reported outcomes of MVr and MVR after a prior mitral valve repair. Data regarding operative mortality, clinical outcomes and complications were extracted, synthesized and meta-analysed where appropriate. Results Eight studies with a total cohort of 1632 patients were used. After analysis, no significant differences in the short term and long-term operative mortality, incidence of stroke, congestive heart failure, Grade 1 and Grade 2 mitral regurgitation, requirement of 3rd mitral valve operation and reoperation due bleeding were found between the two groups. However, a slightly higher incidence of postoperative atrial fibrillation (OR: 0.11, CI: 0.02 to 0.17, I2 = 0%, p = 0.02) was observed in the MVR group, as compared to the MVr group. Conclusion MVr appears to be a viable alternative to MVR for mitral valve reoperation, given that they are associated with similar post-operative outcomes.
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Affiliation(s)
- Muthu Veerappan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System-NUHS, 1E Kent Ridge Road, 9th Floor, Tower Block, Singapore, 119228, Singapore.,School of Medicine, University of Dundee, Dundee, UK
| | - Prashasth Cheekoty
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System-NUHS, 1E Kent Ridge Road, 9th Floor, Tower Block, Singapore, 119228, Singapore.,School of Medicine, Newcastle University, Newcastle, UK
| | - Faizus Sazzad
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System-NUHS, 1E Kent Ridge Road, 9th Floor, Tower Block, Singapore, 119228, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System-NUHS, 1E Kent Ridge Road, 9th Floor, Tower Block, Singapore, 119228, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.
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Yuh DD. Commentary: Mitral valve re-repair: Rejection of imperfection. J Thorac Cardiovasc Surg 2020; 160:1192-1193. [PMID: 31926690 DOI: 10.1016/j.jtcvs.2019.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David D Yuh
- Department of Surgery, Stamford Hospital, Stamford, Conn.
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