Internal Mammary Artery Bypass Graft Research Articles

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

The Value of Left Internal Mammary Artery Flow Velocity in Predicting the Prognosis of Patients After Coronary Artery Bypass Grafting.

The purpose of this study was to explore the value of the left internal mammary artery flow velocity (LIMAV) measured by ultrasound before coronary artery bypass grafting (CABG) in predicting the prognosis of patients after left internal mammary artery (LIMA) bypass grafting. One hundred and four patients who underwent CABG with LIMA as the bridge vessel in the cardiovascular surgery department of our hospital between May 2018 and June 2019 were selected. All patients underwent transthoracic Doppler ultrasonography to measure LIMAV preoperatively. Intraoperatively, mean graft flow (MGF) and pulsatility index (PI) of the LIMA bridge were measured using transit time flow measurement (TTFM). The primary endpoint event in this study was cardiac death within 18 months after surgery. The Cox survival analysis showed that the MGF, the LIMAV and left ventricular ejection fraction (LVEF) were risk factors for death after CABG. The cut-offs of MGF, LIMAV and LVEF for the prediction of death after CABG were ≤ 14 mL/min (area under the curve (AUC): 0.830; sensitivity: 100%; specificity: 65.6%), ≤ 60 cm/s (AUC: 0.759; sensitivity: 65.5%; specificity: 85.3%), and ≤ 44% (AUC: 0.724; sensitivity: 50%; specificity: 88.5%), respectively. Compared with the use of MGF, MGF + LIMAV, combination of the MGF + LIMAV + LVEF (AUC: 0.929; sensitivity: 100%; specificity: 81.1%) resulted in a stronger predictive value (MGF vs. MGF + LIMAV + LVEF: P = 0.02). LIMAV measured by preoperative transthoracic ultrasound combined with intraoperative MGF and LVEF may have a greater value in predicting patients' risk of cardiac death after CABG.

Long-term outcomes of percutaneous revascularization for internal mammary artery-left anterior descending artery bypass failure.

Despite the excellent long-term results of internal mammary artery (IMA)-left anterior descending (LAD) bypass, percutaneous revascularization of IMA is sometimes required for IMA-LAD bypass failure. However, its clinical outcomes have not been fully elucidated. The aim of this study was to investigate the long-term clinical outcomes, including target lesion revascularization (TLR) following contemporary percutaneous revascularization of failed IMA bypass graft. We examined data of 59 patients who had undergone percutaneous revascularization of IMA due to IMA-LAD bypass failure at nine hospitals. Patients with IMA graft used for Y-composite graft or sequential bypass graft were excluded. The incidence of TLR was primarily examined, whereas other clinical outcomes including cardiac death, myocardial infarction, and target vessel revascularization were also evaluated. Mean age of the enrolled patients was 67.4 ± 11.3years, and 74.6% were men. Forty patients (67.8%) had anastomotic lesions, and 17 (28.8%) underwent revascularization within three months after bypass surgery. Procedural success was achieved in 55 (93.2%) patients. Stent implantation was performed in 13 patients (22.0%). During a median follow-up of 1401days (interquartile range, 282-2521days), TLR was required in six patients (8.5% at 1, 3, and 5years). Patients who underwent percutaneous revascularization within 3months after surgery tended to have a higher incidence of TLR. Clinical outcomes of IMA revascularization for IMA-LAD bypass failure were acceptable.

VENTRICULAR ELECTRICAL STORM SECONDARY TO KINKING OF LEFT INTERNAL MAMMARY ARTERY BYPASS GRAFT

VENTRICULAR ELECTRICAL STORM SECONDARY TO KINKING OF LEFT INTERNAL MAMMARY ARTERY BYPASS GRAFT

Vascular Access-Site Choice and Outcomes in Patients With Previous Coronary Artery Bypass Surgery Undergoing Coronary Catheterization in a High-Volume Transradial Center.

Transradial access for coronary angiography was observed to be superior to femoral access. Nevertheless, femoral artery access is still frequently used, especially in challenging subgroups with high procedural complexity, like patients with previous coronary artery bypass grafting (CABG). We analyzed access-site choice and outcomes of CABG patients undergoing coronary catheterization in different clinical settings. A total of 1206 consecutive CABG patients undergoing coronary angiography and intervention were included in this study. Procedural and clinical outcomes were compared between transradial and transfemoral access. Multivariate logistic regression analysis was performed to identify predictors of access-site choice. Coronary catheterization was performed via radial access in 753 patients (63.1%) and via femoral access in 442 patients (36.9%). During the study period, femoral artery utilization dropped from 55.2% to a minimum of 28.2% per year (P<.01). Short stature (odds ratio [OR], 1.62; P<.01), peripheral artery disease (OR, 1.42; P=.04), cardiopulmonary resuscitation (CPR) (OR, 4.17; P<.001), ST-segment elevation myocardial infarction (STEMI) (OR, 2.56; P=.01), and coexisting left and right internal mammary artery (LIMA/RIMA) bypass grafts (OR, 2.67; P<.001) were independently associated with femoral access-site choice. Study outcomes including access-site complications (4.3% vs 1.6%; P<.01) as well as short- and long-term mortality (30-day mortality: 6.8% vs 2.0%; hazard ratio, 3.52; 95% confidence interval, 1.84-6.70; P<.001) were more likely to occur with femoral access. Length of stay was shorter in the radial cohort (3.7 ± 5.1 days vs 5.3 ± 7.2 days; P<.001). Radial access appears to be favorable even in complex CABG patients. Although radial access was set as the standard vascular approach, femoral access was chosen in one-third of all patients. Independent predictors for femoral access were short stature, peripheral artery disease, acute settings like CPR and STEMI, as well as coexisting LIMA and RIMA grafts.

String sign recovery of the left internal mammary artery bypass graft.

String sign recovery of the left internal mammary artery bypass graft.

Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts

BackgroundQuantitative myocardial perfusion mapping using cardiovascular magnetic resonance (CMR) is validated for myocardial blood flow (MBF) estimation in native vessel coronary artery disease (CAD). Following coronary artery bypass graft (CABG) surgery, perfusion defects are often detected in territories supplied by the left internal mammary artery (LIMA) graft, but their interpretation and subsequent clinical management is variable.MethodsWe assessed myocardial perfusion using quantitative CMR perfusion mapping in 38 patients with prior CABG surgery, all with angiographically-proven patent LIMA grafts to the left anterior descending coronary artery (LAD) and no prior infarction in the LAD territory. Factors potentially determining MBF in the LIMA–LAD myocardial territory, including the impact of delayed contrast arrival through the LIMA graft were evaluated.ResultsPerfusion defects were reported on blinded visual analysis in the LIMA–LAD territory in 27 (71%) cases, despite LIMA graft patency and no LAD infarction. Native LAD chronic total occlusion (CTO) was a strong independent predictor of stress MBF (B = − 0.41, p = 0.014) and myocardial perfusion reserve (MPR) (B = − 0.56, p = 0.005), and was associated with reduced stress MBF in the basal (1.47 vs 2.07 ml/g/min; p = 0.002) but not the apical myocardial segments (1.52 vs 1.87 ml/g/min; p = 0.057). Extending the maximum arterial time delay incorporated in the quantitative perfusion algorithm, resulted only in a small increase (3.4%) of estimated stress MBF.ConclusionsPerfusion defects are frequently detected in LIMA–LAD subtended territories post CABG despite LIMA patency. Although delayed contrast arrival through LIMA grafts causes a small underestimation of MBF, perfusion defects are likely to reflect true reductions in myocardial blood flow, largely due to proximal native LAD disease.

Incidental Finding and Endovascular Repair of a Left Internal Mammary Artery Aneurysm following a Multivessel Coronary Artery Bypass Graft

True aneurysms discovered within the internal mammary artery are extremely rare and typically have an asymptomatic occurrence. Their presentation and management have also been variable due to their low incidence, decreased detection, or lack of documentation. They have a high risk for morbidity or mortality as they can possibly rupture with increasing size and thus become life-threatening. Coronary CT angiography is the most definitive test for confirming and finding complications related to the aneurysm. With an increase in the aging population and advancement in the techniques used in coronary artery bypass grafting, it is likely that the rate of recorded occurrence of aneurysms and pseudoaneurysms will increase. Endovascular repair is currently the most favored treatment modality. In this report, we describe a case of a 74-year-old male who was incidentally found to have a left internal mammary artery aneurysm following complaints of chest pain related to another nearly occluded grafted vessel. To the best of our knowledge, and following an extensive literature review, this is likely the first documented case of a true aneurysm found within a left internal mammary artery bypass graft. The patient recovered well following placement of a covered stent; however, upon follow-up one year later, he was found to have stenosis of the same vessel, which was subsequently treated without further complication.

Bilateral internal mammary grafting: Are the advantages obvious?

Background. The use of one internal thoracic artery has long been considered a gold standard for coronary artery bypass grafting. However, despite the benefits, the frequency of using both internal mammary arteries remains low. The relationship between improving coronary artery bypass grafting results and the risk of complications after surgery using two internal thoracic arteries are yet to be resolved.Aim. We compared immediate and mid-term outcomes of coronary artery bypass grafting using one and two mammary arteries.Methods. Two hundred and thirty-one (231) patients with coronary artery disease, after microscope-assisted coronary artery bypass surgery, were categorised into two groups: group I — patients had received one internal mammary artery during surgery (n = 177), and group II — patients had received two internal mammary arteries during surgery (n = 54). Propensity-score matching was applied to reduce differences between groups, therefore two groups of 50 patients were obtained after matching.Results. Operations with bilateral internal mammary grafting in comparison to single internal mammary grafting were associated with longer operating times (group I: 167.5 [150-190] min., group II: 205 [190–220] min., p &lt; 0.001) and increased aortic cross-clamp times (group I: 37.5 [32–45] min., group II: 44 [39–48] min., p = 0.012), but cardiopulmonary bypass duration was similar (group I: 65.5 [56–78] min. and group II: 69 [58–78] min., p = 0.95). No differences were observed for adverse event frequencies (i.e. death, myocardial infarction, acute cerebrovascular accidents and repeated revascularisation) and sternal wound complications in the early- and long-term post-operation. The grafts patency in groups I and II before discharge was 98.0 vs. 92.5 % (p = 0.195) and 94.6 vs. 92.5 % (p = 0.582) for mammary and venous grafts, respectively. At follow-up time (29.5 ± 18.7 months), group I was associated with significantly improved actuarial overall survival (p = 0.021) and were composite survival free from cardiac-related mortality, myocardial infarction, repeat revascularisation and stroke (p = 0.008). Complete revascularisation was associated with a reduced risk of major cardiac events (OR, 0.41; 95% CI: 0.20–0.85).Conclusion. Bilateral internal mammary artery coronary artery bypass grafting in comparison with single internal mammary grafting was associated with increased operation times, similar grafts patency, early and late outcomes, but no overall improved survival and composite freedom from major adverse cardiac events in the mid-term. Complete revascularisation may be considered an independent prognostic factor after coronary bypass surgery and may be more clinically relevant than both internal thoracic arteries. Received 29 April 2020. Revised 8 September 2020. Accepted 9 September 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Impacts of Skeletonized Bilateral Internal Mammary Artery Bypass Grafting on the Risk of Deep Sternal Wound Infection.

This single-center study aimed to evaluate the incidence of deep sternal wound infection (DSWI) following skeletonized bilateral internal mammary artery (BIMA) harvest in a Chinese cohort. Using propensity score matching, this study also provided a present-day assessment of the impacts of skeletonized BIMA grafting versus skeletonized single internal mammary artery (SIMA) grafting on early outcomes.From January 2014 to December 2017, 2403 eligible patients were entered into either a BIMA group (n = 368) or a SIMA group (n = 2035). The incidence of DSWI was recorded. Analysis of early outcomes was further performed for propensity score-matched (1:1) cohorts.The BIMA group received a similar incidence of DSWI as did the SIMA group (1.6% versus 0.9%, P = 0.247). No significant differences between subgroup diabetic-BIMA, subgroup nondiabetic-BIMA, subgroup diabetic-SIMA, and subgroup nondiabetic-SIMA were found regarding the incidence of DSWI (2.0%, 1.4%, 1.0%, and 0.7%, respectively; P > 0.05 between groups). After matching, treatment type (skeletonized BIMA grafting versus skeletonized SIMA grafting) was not an independent risk factor for postoperative DSWI (OR = 1.309, 95% CI 0.897-2.714, P = 0.704) or predictors of other early outcomes. Additionally, the two matched groups shared similar early outcomes (including postoperative DSWI), regardless of whether or not the merger with diabetes (all P > 0.05).Skeletonized BIMA harvest as compared with skeletonized SIMA harvest was not associated with an increased risk of DSWI, regardless of whether or not the merger with diabetes. Patients with skeletonized BIMA grafting received similar surgical mortality and major postoperative morbidity as did matched patients with skeletonized SIMA grafting.

OC62 REDO MITRAL SURGERY AND HOSPITAL OUTCOME: IMPACT OF FAILED MITRAL VALVE REPAIR

Background and Aim: Mitral valve repair is the gold standard for mitral valve regurgitation, even if failed mitral repairs (FMR) have been reported. The aim of this study was to evaluate the impact of FMR on early outcome after redo mitral surgery. Methods: Operative mortality and major morbidity events from 920 redo mitral procedures at nine European centres were analysed. Statistical analysis was performed by the SPSS 13.0 program for Windows (SPSS, Inc., Chicago, IL, USA). To identify indipendent predictors of operative deaths, variables with a P &lt; 0.10 at univariable analysis were included in the regression models. All the outcome parameters were then adjusted by propensity matching, to compare similar cohorts of patients with FMR or diseased native mitral valves and similar cohorts of patients with FMR and malfunctioning prostheses. Results: FMR did not impact mortality at multivariable analysis (P = 0.64). Propensity-matched cohorts of FMR and native mitral valves showed no differences in mortality (P = 0.69). A preoperative Global Initiative for Chronic Obstructive Lung Disease score &gt;2 chronic lung disease (COPD) (OR 15.2, P &lt; 0.01), left ventricular ejection fraction &lt;30% (odds ratio (OR) 21.5, P = 0.005), major injury to cardiovascular structures at re-entry (OR 27.2, P &lt; 0.01) or to patent left internal mammary artery-coronary artery bypass graft (OR 7.6, P = 0.03) predicted mortality in the FMR population. Conclusions: A failed mitral repair does not impact hospital outcome of redo surgery. Severe left ventricular dysfunction, COPD and injury at re-entry predict adverse early outcome.

P4567Do women benefit from bilateral internal mammary artery bypass grafting?

P4567Do women benefit from bilateral internal mammary artery bypass grafting?

Bilateral versus single internal mammary artery bypass grafts for coronary arterial atherosclerosis

Bilateral versus single internal mammary artery bypass grafts for coronary arterial atherosclerosis

Bilateral Internal Mammary Artery Bypass Grafting: Sternal Wound Infection in High-Risk Population. Should Sternal Infection Scare Us?

Background:Bilateral internal mammary arteries (BIMAs) remain underused in coronary artery bypass grafting (CABG), especially in elderly, diabetic, and obese patients. This study investigated incidence of sternal wound infection (SWI), sternal instability (SI), and reintervention for bleeding (RIB) in this high-risk population.Methods:A single-center retrospective observational study was performed in “Grand Hôpital de Charleroi, Gilly, Belgium.” A total of 319 patients undergoing CABG from December 2011 to December 2015 were included. Three main outcome measures (SWI, SI, and RIB) were investigated in obese vs nonobese, diabetic vs nondiabetic, and elderly vs younger patients.Results:In all, 14 SWI, 11 SI, and 6 RIB were discounted. Death rate was as follows: SWI: 2/14 vs 17/305 (P = .178), SI: 2/11 vs 17/308 (P = .081), and RIB: 2/6 vs 17/313 (P = .004). In obese (n = 113) vs nonobese (n = 206) patients, there was no difference for SWI (P = .263), SI (P = .565), and RIB (P = .332). In diabetic (n = 118) vs nondiabetic (n = 201) patients, there was no difference for SWI (P = .642), SI (P = .497), and RIB (P = .298). In elderly (n = 62) vs younger (n = 257) patients, there was no difference for SWI (P = .619), SI (P = .915), and RIB (P = .385).Conclusions:Obesity, age, and diabetes treated by insulin (or not) do not seem to be risk factors for developing SWI, SI, or RIB in patients receiving a CABG using BIMA. Nevertheless, mortality was higher in RIB group.

In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery.

This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The mid-term survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.

High-Output Cardiac Failure and Coronary Steal With an Arteriovenous Fistula

Creation of an arteriovenous access for hemodialysis can provoke a sequence of events that significantly affects cardiovascular hemodynamics. We present a 78-year-old man with end-stage renal disease and concomitant coronary artery disease previously requiring coronary artery bypass grafting including a left internal mammary graft to the left anterior descending artery, ischemic cardiomyopathy with left ventricular systolic dysfunction, and severe aortic stenosis who developed hypotension unresponsiveto medical therapy after recent angioplasty of his ipsilateral arteriovenous fistula for high-grade outflow stenosis. This case highlights the long-term effects of dialysis access on the cardiovascular system, with special emphasis on complications such as high-output cardiac failure and coronary artery steal syndrome. Banding of the arteriovenous fistula provided symptomatic relief with a decrease in cardiac output. Avoidance of arteriovenous access creation on the ipsilateral upper extremity in patients with a left internal mammary artery bypass graft may prevent coronary artery steal syndrome.

Long-term Outcomes of Carotid-Subclavian Bypass in the Setting of Thoracic Endovascular Aortic Repair

Subclavian artery revascularization is frequently performed in the setting of thoracic endovascular aortic repair (TEVAR) for a variety of indications ranging from prophylactic prevention of upper extremity and spinal cord ischemia to preservation of hemodialysis access or left internal mammary artery coronary artery bypass graft. Despite this, there is little information on the short- and long-term outcomes of patients undergoing carotid to subclavian artery bypass. We sought to define the outcomes associated with this procedure. Patients undergoing carotid-subclavian bypass in conjunction with TEVAR between June 2005 and September 2016 were retrospectively identified from a prospectively maintained, single-center aortic surgery database. Categorical and continuous variables were compared using χ2 and Wilcoxon rank sum tests, respectively. The 30-day outcomes specific to the carotid-subclavian bypass procedure were analyzed, including nerve injury, bleeding complications, and local vascular complications. All preoperative and postoperative chest radiographs were carefully analyzed to assess for hemidiaphragm elevation indicative of phrenic nerve palsy. Long-term outcomes included primary graft patency and anastomotic complications. Of 579 patients undergoing TEVAR during this time interval, 114 patients (20%) underwent concomitant carotid-subclavian bypass. The cohort was 39% female (n = 44), with a mean age of 65 ± 14 years. The majority of conduits were 8-mm polytetrafluoroethylene grafts (n = 107 [92.2%]), with a minority being reversed saphenous vein grafts (n = 4 [3.5%]). The bypass procedure was done concomitantly at the time of TEVAR in 90.4% (n = 103) of cases. The short-term complication rate attributed specifically to the carotid-subclavian bypass was 21% (n = 24). These complications included neck hematoma requiring re-exploration in 0.9% (n = 1), recurrent laryngeal nerve palsy in 5.3% (n = 6), axillary nerve palsy in 1.8% (n = 2), and phrenic nerve palsy in 13.2% (n = 15) of patients. The 30-day all-cause mortality rate was 5.3% (n = 6), and the rate of permanent paraparesis or paraplegia was 0.9% (n = 1). Of the operative survivors (n = 108), follow-up imaging of the bypass graft was available in 84% (n = 96) of patients. Actuarial primary graft patency was 97% at 10 years (Fig). There were three patients (2.5%) with bypass graft occlusions, two of which were clinically silent and detected in follow-up imaging. The third was detected because of the symptoms of subclavian steal and required repeated revascularization. Two patients (1.8%) developed a late anastomotic pseudoaneurysm requiring either endovascular (n = 1) or surgical (n = 1) intervention. Carotid-subclavian bypass for revascularization of the subclavian artery performed in the setting of TEVAR is durable, although the true complication rate is likely to be higher than generally reported in the literature because of a not insignificant rate of phrenic nerve palsy. These data should serve well as “gold standard” comparison data for emerging branch graft devices.

Invited Commentary

Invited Commentary

Revascularización miocárdica con uso de doble arteria mamaria interna y morbilidad esternal. Experiencia de un centro

Introduction and objectivesThe use of double internal mammary artery in coronary artery bypass grafting has been associated with increased sternal complications, especially in diabetic and obese patients.The aim of this article is to review the risk factors for those patients who underwent coronary artery bypass grafting with the use of double internal mammary artery and to analyse the sternal complication rate in this group. MethodsA total 526 patients revascularized with use of double internal mammary artery were selected from our database.The mean age of the patients was 59 years, with a mean logistics EuroScore I of 2.7%. ResultsThere were a total of 3 (0.57%) cases with sternal instability, which did not correspond with any risk factor.A sternal associated infection was observed in 31 (5.9%) patients, but only 2 of them developed deep infection/mediastinitis (0.38%).Of the patients who had superficial infection of the surgical wound (29 patients, 5.5%), there was a higher incidence in women, patients with renal failure, and those who received a transfusion of packed red blood cells during the surgery. These findings were statistically significant (P<.05).There was also a higher incidence (with no statistically significant differences) of superficial infection in patients with diabetes, COPD, obese, smokers, and those who underwent incomplete myocardial revascularisation. ConclusionsIn our experience, the use of double internal mammary artery was not accompanied by an increased incidence of sternal instability, but it was associated with superficial infections, in the group of female patients, renal disease, and those who needed red blood cells during the surgery. To maintain the benefit of the double internal mammary artery bypass grafting in these patients, special care should be taken, and new strategies for sternal closure should be implemented.

Impact of failed mitral valve repair on hospital outcome of redo mitral valve procedures.

The prognostic impact of failed mitral valve repair (FMR) on in-hospital outcome after redo mitral valve surgery has not been thoroughly investigated. Hospital outcomes after redo mitral valve surgery because of an FMR in patients from nine European centres were reported. Logistic regressions identified predictors of mortality in combined or isolated redo mitral valve operations. Hospital outcome was compared between propensity-matched cohorts with FMR and native mitral valves in the context of redo surgery and FMR versus failed prostheses. A total of 246 patients with FMR yielded a 6.5% mortality rate at redo surgery. FMR per se did not impact mortality at multivariable analysis ( P = 0.64). A preoperative Global Initiative for Chronic Obstructive Lung Disease (GOLD) score ≥2 chronic obstructive lung disease (COPD) (OR 15.2, P < 0.01), left ventricular ejection fraction <30% (odds ratio (OR) 21.5, P = 0.005), major injury to cardiovascular structures at re-entry (OR 27.2, P < 0.01) or injury to patent left internal mammary artery-coronary artery bypass graft (OR 7.6, P = 0.03) predicted mortality in the whole FMR population. GOLD ≥ 2 COPD (OR 12.3, P = 0.049), age at surgery (OR 1.15 for each incremental year, P = 0.049) and cardiopulmonary bypass duration (OR 1.02, P = 0.022) predicted mortality in isolated redo mitral valve surgery for FMR. The fourth (> 68 years = 13.8% mortality) and the fifth quintiles of age (≥73.4 years = 14.8%) reported the highest mortality (OR 3.8 and 4.2 respectively, P = 0.002) in this subgroup. Propensity-matched cohorts of FMR and native mitral valves in the context of redo surgery showed no differences in terms of mortality ( P = 0.69) and major morbidity (acute myocardial infarction P = 0.31, stroke P = 0.65, acute kidney injury P = 1.0), whereas more perioperative dialysis ( P = 0.04) and transfusions ( P = 0.02) were noted in propensity-matched failed prostheses compared to FMR. A failed mitral repair does not impact hospital outcome of redo surgery. Given the role of severe left ventricular dysfunction and advanced age on hospital mortality rates, an early indication for redo surgery may improve outcome.