Experience in Reoperation for Failure of Mitral Valve Repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUSheng , ZHONGZhao-ji , YINZhao-hua , SUNHai-ning , SONGYun-hu , LUFeng , WANGShui-yun , WANGXin ,  XUJian-ping

Department of Cardiovascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Science, Beijing 100037, P. R. China;

Corresponding author：

XUJian-ping, Email: jianpingxu@263.net

Keywords：

Mitral valve repair; Reoperation; Causes

DOI：

10.7507/1007-4848.20160252

Video：

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Objective To examine the cause of failure of mitral valve repair. Method We retrospectively anal-yzed the clinical data of 89 consecutive patients with non-rheumatic mitral valve diseases who underwent reoperation for failure of mitral valve repair in our hospital from January 2009 through January 2016. There were 54 males and 35 females at age of 36.2±17.4 years. Results There were 16 patients with reoperation of mitral valve repairs and 73 patients of mitral valve replacements. The failure reasons of initial mitral valve repair were technique-related in 63 patients (70.8%) and valve-related in 18 patients (20.2%). Technique-related causes of repair failure included leaflet suture dehiscence (20 patients, 22.5%), edge-to-edge procedure (11 patients, 12.4%), leaflet thickening or retraction (11 patients, 12.4%), ring dehiscence (8 patients, 9.0%), inappropriate annuloplasty (6 patients, 6.7%), incomplete repair (4 patients, 4.5%), and chordal elongation or rupture (3 patients, 3.4%). Median interval since previous repair was 4.0 (0.04-18.0) years for the technique-related failure group, and 9.7 (0.21-35.6) years for valve-related failure group (P < 0.05). Conclusion Technique-related factors are main causes of repair failure, which include leaflet suture dehiscence, edge-to-edge procedure, and leaflet thickening or retraction. Reoperation for technique-related failure needs to be adopted early.

Citation： LIUSheng, ZHONGZhao-ji, YINZhao-hua, SUNHai-ning, SONGYun-hu, LUFeng, WANGShui-yun, WANGXin, XUJian-ping. Experience in Reoperation for Failure of Mitral Valve Repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1073-1076. doi: 10.7507/1007-4848.20160252 Copy

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3.	Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230-237.
4.	Mcneely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157-162.
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6.	Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
7.	Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885-893.
8.	Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: a 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828-1837.
9.	el Asmar B, Perier P, Couetil JP, et al. Failures in reconstructive mitral valve surgery. J Med Liban, 1991, 39(1): 7-11.
10.	Duran CM. Perspectives in reparative surgery for acquired valvular disease. Adv Card Surg, 1993, 4: 1-23.
11.	Gillinov AM, Cosgrove DM, Lytle BW, et al. Reoperation for failure of mitral valve repair. J Thorac Cardiovasc Surg, 1997, 113(3): 467-475.
12.	Suri RM, Schaff HV, Dearani JA, et al. Recurrent mitral regurgita-tion after repair: should the mitral valve be re-repaired? J Thorac Cardiovasc Surg, 2006, 132(6): 1390-1397.
13.	Dumont E, Gillinov AM, Blackstone EH, et al. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg, 2007, 84(2): 444-450.
14.	Zegdi R, Sleilaty G, Latremouille C, et al. Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience. Ann Thorac Surg, 2008, 86(5): 1480-1484.
15.	Anyanwu AC, Itagaki S, Varghese R, et al. Re-repair of the mitral valve as a primary strategy for early and late failures of mitral valve repair. Eur J Cardiothorac Surg, 2014, 45(2): 352-358.
16.	於文达, 范阜东, 邵峻, 等.二尖瓣双孔成形术后中长期随访.中国胸心血管外科临床杂志, 2015, 22(1): 9-14.
17.	李进华, 来永强, 王炯, 等. "缘对缘"二尖瓣成形术对左心室舒张功能的影响.中国胸心血管外科临床杂志, 2009, 16(5): 344-347.

1. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962-970.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guide-line for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): e1-e132.
3. Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230-237.
4. Mcneely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157-162.
5. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes follo-wing surgical mitral valve repair or replacement. Eur J Cardiothorac Surg, 2007, 31(2): 267-275.
6. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
7. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885-893.
8. Daneshmand MA, Milano CA, Rankin JS, et al. Mitral valve repair for degenerative disease: a 20-year experience. Ann Thorac Surg, 2009, 88(6): 1828-1837.
9. el Asmar B, Perier P, Couetil JP, et al. Failures in reconstructive mitral valve surgery. J Med Liban, 1991, 39(1): 7-11.
10. Duran CM. Perspectives in reparative surgery for acquired valvular disease. Adv Card Surg, 1993, 4: 1-23.
11. Gillinov AM, Cosgrove DM, Lytle BW, et al. Reoperation for failure of mitral valve repair. J Thorac Cardiovasc Surg, 1997, 113(3): 467-475.
12. Suri RM, Schaff HV, Dearani JA, et al. Recurrent mitral regurgita-tion after repair: should the mitral valve be re-repaired? J Thorac Cardiovasc Surg, 2006, 132(6): 1390-1397.
13. Dumont E, Gillinov AM, Blackstone EH, et al. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg, 2007, 84(2): 444-450.
14. Zegdi R, Sleilaty G, Latremouille C, et al. Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience. Ann Thorac Surg, 2008, 86(5): 1480-1484.
15. Anyanwu AC, Itagaki S, Varghese R, et al. Re-repair of the mitral valve as a primary strategy for early and late failures of mitral valve repair. Eur J Cardiothorac Surg, 2014, 45(2): 352-358.
16. 於文达, 范阜东, 邵峻, 等.二尖瓣双孔成形术后中长期随访.中国胸心血管外科临床杂志, 2015, 22(1): 9-14.
17. 李进华, 来永强, 王炯, 等. "缘对缘"二尖瓣成形术对左心室舒张功能的影响.中国胸心血管外科临床杂志, 2009, 16(5): 344-347.

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