Outcomes of Re-Repair vs Replacement After Failed Primary Mitral Regurgitation Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis.

Abstract

With the increasing incidence of primary mitral valve repair, the number of patients requiring reintervention for degenerative mitral regurgitation (MR) has also increased. We examined whether mitral valve re-repair is superior to replacement after failed repair for degenerative MR. Patients undergoing isolated surgical mitral valve repair for degenerative MR were identified from The Society of Thoracic Surgeons Adult Cardiac Surgery Database between July 2011 and December 2023. Failed mitral repair was defined as any subsequent reoperations after 30 days on the mitral valve. Predictors for re-repair were calculated by multivariable logistic regression, and longitudinal survival was analyzed with linkage to the National Death Index and the Centers for Medicare & Medicaid Services data using Cox regression. Overall, 1749 patients required reoperation on the mitral valve during the study period, including 410 (23.4%) re-repairs and 1339 (76.6%) replacements. Unadjusted overall survival was superior for patients undergoing re-repair compared with replacement (hazard ratio [HR], 3.54; 95% CI, 2.01-6.24; P < .001). This survival benefit persisted even after extensive risk adjustment (HR, 1.96; 95% CI, 1.10-3.52; P = .022) and propensity score matching (HR, 1.95; 95% CI, 1.01-3.82; P = .045) controlling for patient and valve-related characteristics. Re-repair patients had lower postoperative morbidity or mortality (6.8% vs 11%; P = .042), with no differences in postoperative stroke or reoperation. In this largest to date analysis of reoperations for degenerative MR, those undergoing re-repair were found to have superior intermediate-term survival compared with mitral valve replacement. These findings suggest that re-repair may be preferred in eligible patients with recurrent MR.