Clinical outcomes of isolated redo mitral valve replacement in patients with mitral prosthetic heart valve dysfunction

Abstract

Objectives: Redo mitral valve replacement (redo-MVR) represents a clinical challenge due to a 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 post-operative complications included major bleeding (n=11) post-operative 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.