Repeat crossclamp after failed initial degenerative mitral valve repair is safe and successfulCentral MessagePerspective
Catherine M. Wagner, MD,
Whitney W. Fu, MD,
Alexander A. Brescia, MD, MSc,
Robert B. Hawkins, MD, MSc,
Matthew A. Romano, MD,
Gorav Ailawadi, MD, MBA,
Steven F. Bolling, MD
Affiliations
Catherine M. Wagner, MD
Address for reprints: Catherine M. Wagner, MD, Department of Cardiac Surgery, 1500 E Medical Center Dr, Ann Arbor, MI 48109.; Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Whitney W. Fu, MD
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Alexander A. Brescia, MD, MSc
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Robert B. Hawkins, MD, MSc
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Matthew A. Romano, MD
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Gorav Ailawadi, MD, MBA
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Steven F. Bolling, MD
Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich; Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
Objective: Surgical risk and long-term outcomes when re-crossclamp is required during degenerative mitral valve repair are unknown. We examined the outcomes of patients who required re-crossclamp for mitral valve reintervention. Methods: Adults undergoing mitral valve repair for degenerative mitral valve disease at a single center from 2007 to 2021 who required more than 1 crossclamp for mitral valve reintervention were included. Outcomes including major morbidity and 30-day mortality were collected. Kaplan–Meier analysis characterized survival and freedom from recurrent mitral regurgitation. Results: A total of 69 patients required re-crossclamp for mitral valve reintervention. Of those, 72% (n = 50) underwent successful re-repair and the remaining underwent mitral valve replacement (28%, n = 19). Major morbidity occurred in 23% (n = 16). There was no 30-day mortality, and median long-term survival was 10.9 years for those undergoing re-repair and 7.2 years for those undergoing replacement (P = .79). Midterm echocardiography follow-up was available for 67% (33/50) of patients who were successfully re-repaired with a median follow-up of 20 (interquartile range, 7-37) months. At late follow-up, 90% of patients had mild or less mitral regurgitation. Of those re-repaired, 2 patients later required mitral valve reintervention. Conclusions: Patients requiring re-crossclamp for residual mitral regurgitation had low perioperative morbidity and no mortality. Most patients underwent successful re-repair (vs mitral valve replacement) with excellent valve function and long-term survival. In the event of unsatisfactory repair at the time of mitral valve repair, attempt at re-repair is safe and successful with the appropriate valvar anatomy.
