Early and long-term outcomes following redo mitral valve surgery in patients with prior minimally invasive mitral valve surgery.

OBJECTIVES: The frequency of minimally invasive mitral valve surgery has steadily increased over the last decades and therefore surgeons are now encountering an increasing number of patients requiring mitral valve reoperations post-minimally invasive mitral valve surgery. The aim of this study was to analyze the early postoperative outcomes and the long-term survival in patients who undergo reoperative mitral valve surgery following previous minimally invasive surgery.

METHODS: Patients who underwent redo mitral valve surgery following prior minimally invasive mitral valve surgery between January 2002 and December 2021 were included in our analysis. Study data were prospectively collected and retrospectively analyzed. The primary outcomes were 30-day mortality and long-term survival.

RESULTS: Among the 187 included patients, 34 (18.2%) underwent repeat mitral valve repair and 153 (81.8%) mitral valve replacement. Median age was 66 years (Interquartile range 56-74) and 80 (42.8%) patients were female. Redo mitral valve surgery was performed through median sternotomy in 169 patients (90.4%). A total of 77 (41.2%) patients had additional concomitant procedures. Median ICU stay was 1 day (1-5). The 30-day mortality was 6.4% (12/187). Estimated survival at 5 and 12 years was 61.8% and 38.3%, respectively. Preoperative stroke (HR 3.28, 95% CI 1.37-7.85, p = 0.007) as well as infective endocarditis (HR 1.85; 95% CI 1.09-3.11, p = 0.021) were independent predictors of long-term mortality.

CONCLUSIONS: Redo mitral valve surgery following prior minimally invasive mitral valve surgery can be performed safely with low early perioperative mortality and acceptable long-term survival. Preoperative stroke, infective endocarditis and concomitant tricuspid valve surgery are independent predictors of long-term mortality.