Factors affecting mitral valve reoperation in 317 survivors after mitral valve reconstruction

Abstract

From a very heterogeneous group of 340 patients undergoing mitral valve reconstruction from 1969 through 1988, 313 hospital survivors were analyzed for factors affecting the occurrence of reoperative mitral valve procedures related to native mitral valve dysfunction. Follow-up was 100% and extended from 1 year to 20 years (mean follow-up, 7.2 years). Sixty-three patients (18.5% of the 340) required mitral valve reoperation at a mean postoperative interval of 6 years (range, 1 to 15 years). Incremental risk factors analyzed for the event late mitral valve failure included age, sex, preoperative New York Heart Association class, cause of valvular disease, pathophysiology of the mitral valve, previous mitral valve operation, mitral valve pathology, and estimation of mitral valve function at operation after repair. Mitral valve pathophysiology affected the actuarial freedom from mitral valve replacement ( p = 0.023 [log-rank]). Actuarial freedom from mitral valve reoperation was 90% at 5 years and 80% at 8 years in patients who had either pure mitral regurgitation or isolated mitral stenosis compared with 80% and 72% at 5 and 10 years, respectively, in patients who had mixed mitral stenosis and regurgitation ( p = 0.023). Patients undergoing late reoperation were younger (51.7 ± 1.56 years [± the standard error of the mean]) than those not having reoperation ( p < 0.0003). Durability of the repair was less in patients with rheumatic heart disease ( p < 0.025) and greater in patients with ischemic heart disease ( p < 0.004). Seventy-three percent of patients undergoing reoperation had concomitant operations compared with 68% of those not having reoperation ( p < 0.001). We conclude that patients with rheumatic valvular heart disease, mixed mitral stenosis and mitral regurgitation, or both conditions have a greater risk of late failure of mitral valve reconstructive procedures.