Impact and outcomes of failure mode after mitral valve repair.

Abstract

Mitral valve repair (MVr) is the standard of care for degenerative mitral regurgitation (MR). However, repair failure occurs, stemming either from progression of disease (nontechnical failure, NTF) or suboptimal initial repair (technical failure, TF). This study assesses the impact and outcomes of failure mode in patients requiring reoperation after MVr. A single-center retrospective analysis was conducted on patients reoperated for failed MVr for degenerative MR from 2014 to 2023. Failures requiring open surgical reintervention were classified as NTF or TF, and outcomes were compared between groups. Among 237 patients undergoing reoperation for failed MVr, 42% (n = 99) experienced TF, with 71% (n = 70) of TF repairs originating from outside institutions. Patients with TF presented for reoperation earlier than patients with NTF (mean 4.5 vs 9.5 years, P < .001). Early failure (<2 years) occurred in 52% of TF cases, and 39% of these had greater than mild MR on initial postoperative transesophageal echocardiogram. Re-repair was more common in TF (35.4%) versus NTF (10.1%) (P < .001), and re-repair was associated with reduced length of stay (5 vs 8 days, P = .001). Re-repair was associated with improved survival (P < .001). TF was a common and possibly avoidable mode of MVr failure among patients presenting for mitral reintervention at the author's institution, often due to significant residual MR at the index operation. When reoperation is required, re-repair, when feasible, is associated with favorable outcomes and should be pursued. Achieving residual MR that is mild or less at the time of repair is essential to optimize long-term outcomes.