Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Abstract

Background: Redo mitral valve replacement (redo-MVR) remains a challenge despite advances in surgical techniques. Little is known about the outcomes of redo-MVR in patients with rheumatic heart disease. We aimed To evaluate the in-hospital outcomes and associated risk factors for mortality and morbidity after re-operative mitral valve replacement in patients with initial rheumatic heart disease.
 Methods: This retrospective cohort study included 214 patients, 96 males (44.9%) and 118 females (55.1%), who underwent redo-MVR between January 2015 and December 2020. The mean age was 41.87±11.7 years. European Heart Surgery Risk Assessment System II (EuroSCORE II), Age, Creatinine, Ejection Fraction (ACEF) scores were used for risk stratification. The primary endpoints were in-hospital mortality, major morbidity (renal failure, prolonged ventilation, stroke, reoperation, or deep sternal wound infection), and the composite outcome of mortality and/or morbidity).
 Results: Major morbidities occurred in 31.8% of patients, and the in-hospital mortality rate was 19.6%. Predictors of mortality were New York Heart Association class (NYHA) III/IV (OR: 5.4; p˂ 0.001), cardiogenic shock (OR: 13.74, p˂0.001), low left ventricular ejection fraction (LVEF) (OR: 4.36; p= 0.01), and perioperative intra-aortic balloon pump (OR: 6.79; p= 0.01). The significant predictors of mortality and/or major morbidity were NYHA III/IV (OR: 2.39; p˂0.001), low LVEF (OR: 4.44; p= 0.001), active endocarditis (OR: 2.4; p=0.04), and perioperative IABP (OR: 3.88; p= 0.045). EuroSCORE II had better accuracy than the ACEF score to predict adverse outcomes (AUC: 0.70 [95% CI: 0.63-0.78] versus 0.58 [95% CI: 0.50-0.66], p= 0.01) .
 Conclusion: Advanced NYHA class and low LVEF could be associated with poor outcomes after redo-MVR in patients with primary surgery for rheumatic mitral valve disease. EuroSCORE II is a helpful tool for risk stratification during redo-MVR.