Reoperative analysis after mitral valve repair with glutaraldehyde-treated autologous pericardium.

OBJECTIVES: We reviewed reoperations following mitral valve repair (MVR) that used glutaraldehyde-treated autologous pericardium for mitral regurgitation (MR) to analyse the durability and risk factors for reoperation.

METHODS: We retrospectively analysed 144 patients (mean age 57.9 years) who underwent MVR using glutaraldehyde-treated pericardium from March 1992 to December 2011. A total of 19 reoperations were necessary during the follow-up period (mean 6.9 years). The follow-up rate was 97.8%.

RESULTS: At initial MVR, there were no differences in mitral leaflet augmentation applied to the anterior or posterior leaflets (P = 0.75 and P = 0.40) in both groups. Reoperations were required in 19 patients, and the mean interval between initial and redo operations was 6.7 years. Indications for reoperation included recurrent MR (n = 8), progressive mitral stenosis (n = 8) and recurrent infective endocarditis (n = 3). The rates of freedom from reoperation at 5, 10 and 15 years were 95.2 ± 1.9%, 83.5 ± 4.8% and 66.9 ± 8.5%, respectively. Four patients underwent redo MVR for recurrent MR, and the remaining 15 patients underwent mitral valve replacement. The freedom from reoperation rate in the group who underwent leaflet augmentation was statistically lower than that in the non-augmentation group (96.9 ± 2.2% vs 93.4 ± 3.2% at 5 years and 89.7 ± 4.5% vs 68.8 ± 13.7% at 10 years; log-rank, P = 0.008). Predictors of reoperation were absence of leaflet augmentation (P = 0.086, hazard ratio = 0.194) and persistent MR (P = 0.003, hazard ratio = 5.759).

CONCLUSIONS: We must regularly pay careful attention to implanted pericardium, especially when augmented, as it constitutes a risk factor for reoperations. In addition, secure MVR is mandatory to control persistent MR.