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Valvular heart disease
Original research article
Contemporary outcomes in reoperative mitral valve surgery
  1. Hunter J Mehaffey1,
  2. Robert B Hawkins1,
  3. Sarah Schubert1,
  4. Clifford Fonner2,
  5. Leora T Yarboro1,
  6. Mohammed Quader3,
  7. Alan Speir4,
  8. Jeff Rich2,
  9. Irving L Kron1,
  10. Gorav Ailawadi1
  1. 1 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
  2. 2 Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia, USA
  3. 3 Department of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
  4. 4 INOVA Heart and Vascular Institute, Falls Church, Virginia, USA
  1. Correspondence to Dr Hunter J Mehaffey, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA 22908, USA; jhm9t{at}virginia.edu

Abstract

Objective Data suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes.

Methods All (11 973) open mitral valve cases were evaluated (2002–2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery.

Results Of all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, p<0.0001) and higher resource utilisation. Several factors independently increased risk for composite STS major morbidity and 30-day mortality, including cardiogenic shock (OR 10.3, p=0.0001), severe tricuspid insufficiency (OR 2.3, p=0.001), urgent/emergent status (OR 1.8, p=0.001) and concurrent coronary artery bypass grafting (OR 2.4, p=0.002). The volume of redo mitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era.

Conclusions Redo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted.

  • valve disease surgery
  • mitral regurgitation
  • mitral stenosis
  • epidemiology
  • quality and outcomes of care

https://doi.org/10.1136/heartjnl-2017-312047

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    Footnotes

    • Contributors JHM: primarily responsible for study and manuscript; RBH: helped with statistical analysis; SS: contributed to the writing of the manuscript; CF: provided database support and data collection; LTY: data collection and project design; MQ, AS and JR: data collection and project design; ILK: study design and manuscript; and GA: study design.

    • Competing interests None declared.

    • Ethics approval Institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.