Mechanisms of repair failure after mitral valve repair using chordal replacement.

Background: Mechanisms of repair failure after mitral valve repair (MVr) using chordal replacement and annuloplasty for degenerative mitral regurgitation were analyzed.

Methods: All mitral valve reoperations after isolated MVr using solely chordal replacement and annuloplasty for degenerative mitral regurgitation at the German Heart Center Munich were reviewed. This retrospective observational study aims to analyze mechanisms of repair failure leading to reoperations.

Results: Between 2003 and 2010, a total of 344 patients received MVr with chordal replacement and annuloplasty. During a mean follow-up of 9.7 years (0.00 - 15.9 years) in 38 (11.0%) cases reoperation on the mitral valve was necessary. Reoperations were performed after a mean of 6.8 years (0.00 - 14.1 years). The mechanisms of MVr failure were disease progression (39.5%), technical failure (36.8%) and endocarditis (18.4%). Re-repair was performed in 28.9% and was accomplished using redo annuloplasty (90.9%), chordal replacement (90.9%), resection techniques (27.3%) and leaflet patch reconstruction (9.1%). One patient (2.6%) received transcatheter edge-to-edge repair for reoperation. Mitral valve replacement (MVR) was necessary in 63.2%. Redo MVr was mainly performed in cases of technical failure and MVR was more frequently performed in cases with mitral valve sclerosis. Re-reoperation was necessary in 3/24 cases of MVR and in 2/11 cases of redo MVr after a median of 3.8 (0.01 - 10.04) years.

Conclusions: MVr using chordal replacement allows a variety of methods for re-repair including transcatheter solutions. Redo MVr is more often feasible in cases of technical failure, while MVR for reoperation is more frequently necessary in mitral valve sclerosis.