RISK STRATIFICATION IN RE-OPERATIVE MITRAL VALVE SURGERY

Background and Aim: Reoperative mitral valve (MV) surgery is one of the most challenging and high-risk procedure in cardiac surgery. Aims of this study is to analyse our experience on these patients. Material & Methods: Retrospective single center analysis on patients undergoing reoperative MV surgery after prior repair/replacement through mid-sternotomy. Primary endpoint was 30-day mortality; secondary endpoints were stroke, re-exploration for bleeding, ICU and in-hospital length-of-stay, and independent risk factors for peri-operative mortality. Results: 392 patients were enrolled. Logistic EuroSCORE was 19.1±17.3%, and 263 patients (67.1%) had more than one previous cardiac surgery procedure. Former combined procedures were aortic valve surgery in 26 patients (6.6%), TV surgery in 19 patients (4.8%) and coronary artery by-pass graft (CABG) surgery in 17 patients (4.3%). A right mini- thoracotomy approach was performed in 263 patients (67.1%). Stroke rate was 4.3%, re- exploration for bleeding was 6.9%, median ICU and hospital length-of-stay were 2 and 8 days. 30-day mortality was 7.2%. Creatinine (OR 1.335, 95% CI 1.070-1.665), ejection fraction (OR 0.948, 95% CI 0.921-0.976), previous aortic valve surgery (OR 5.957, 95% CI 2.109-16.820), and diabetes (OR 5.945, 95% CI 2.651-13.392) were identified as independent risk factors for peri-operative mortality Conclusion: MV surgery after prior MV operations still represents a demanding procedure with high peri-operative risk. Nevertheless, surgery is still the gold standard for these patients. We believe that the joint of different setting tailored on the single patient after a proper pre-operative screening is the winning strategy to keep perioperative outcome as low as possible