Our Summary

This research paper looked at the risks and outcomes of a second surgery to replace a previously implanted artificial heart valve (bioprosthetic mitral valve) which has deteriorated over time. This kind of second surgery was generally thought to be quite risky, but no clear data was available.

The researchers examined records from 525 patients who underwent this second valve replacement surgery at the Cleveland Clinic between 1990 and 2017. They found that of the 133 patients who had the valve replacement as a standalone procedure, only one died in hospital. However, of the 392 patients who had additional procedures done at the same time, 28 died in hospital. Most of the deaths in the second group were due to complications such as blood clotting disorders, low blood pressure, and multiple organ failure.

The researchers also found that patients with severe heart failure before the operation, those who also had a coronary artery bypass graft, those with a longer-than-average time on heart-lung bypass machine during surgery, and those who needed multiple blood transfusions were at a higher risk of dying after the operation.

In conclusion, the study suggests that a second surgery to replace a deteriorated artificial heart valve is not as risky as previously thought, especially if it is done as a standalone procedure. However, the risk of death increases if the patient has severe heart failure before the operation, needs a coronary artery bypass graft, spends a long time on a heart-lung bypass machine, or needs multiple blood transfusions. The researchers suggest that careful planning and timing of the operation can help to reduce these risks.

FAQs

  1. What are the long-term outcomes and survival rates following surgical mitral valve re-replacement?
  2. What are the risk factors for mortality after mitral valve re-replacement surgery?
  3. How does the duration of cardiopulmonary bypass and multiple transfusions affect the mortality rate in nonisolated procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve replacement is to closely follow post-operative care instructions, attend all follow-up appointments, and notify their healthcare provider of any new or worsening symptoms. This can help ensure a successful recovery and long-term outcome following the procedure.

Suitable For

Patients who are typically recommended mitral valve replacement are those with structural valve deterioration of bioprosthetic mitral valves, specifically those with bioprosthetic regurgitation or stenosis. Patients who may benefit from mitral valve replacement are those with severe symptoms of heart failure, such as New York Heart Association functional class IV symptoms, as well as those who may require concomitant procedures such as coronary artery bypass grafting. Patients with a history of prolonged cardiopulmonary bypass time and those who may require multiple transfusions may also be recommended for mitral valve replacement. Overall, mitral valve replacement is recommended for patients with bioprosthetic mitral valve deterioration who are at risk for complications and have a significant impact on their quality of life.

Timeline

  • Prior to mitral valve replacement: Patients may experience symptoms such as shortness of breath, fatigue, chest pain, palpitations, and swelling in the legs. They may undergo diagnostic tests such as echocardiograms, stress tests, and cardiac catheterization to determine the severity of their mitral valve disease.

  • Mitral valve replacement surgery: The patient undergoes open-heart surgery to replace the diseased mitral valve with a mechanical or bioprosthetic valve. The surgery may be performed as an isolated procedure or in combination with other cardiac surgeries, such as coronary artery bypass grafting. The patient is typically monitored closely in the intensive care unit postoperatively for any complications.

  • After mitral valve replacement: Patients undergo a period of recovery in the hospital, where they are monitored for signs of infection, bleeding, and other complications. They will be prescribed medications to prevent blood clots and manage their heart condition. Cardiac rehabilitation may be recommended to help with recovery and improve overall heart health. Follow-up appointments with the cardiac surgeon and cardiologist will be scheduled to monitor the function of the new valve and overall heart health. Long-term survival and outcomes will be assessed to ensure the success of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with mitral valve replacement surgery?
  2. What is the expected recovery time after mitral valve replacement surgery?
  3. How long can I expect the replacement valve to last?
  4. What follow-up care will be necessary after the surgery?
  5. Are there any lifestyle changes or restrictions I should be aware of after the surgery?
  6. What symptoms should I watch for that may indicate a problem with the replacement valve?
  7. What are the factors that may increase the risk of complications or reduce the long-term success of the replacement valve?
  8. Are there any alternative treatment options to mitral valve replacement that I should consider?
  9. How often will I need to have follow-up appointments or tests to monitor the function of the replacement valve?
  10. What is the success rate of mitral valve replacement surgery in patients with my specific condition?

Reference

Authors: Javadikasgari H, Chemtob RA, Gillinov AM, Pettersson GB, Lowry AM, Desai MY, Svensson LG, Blackstone EH, Wierup P. Journal: J Thorac Cardiovasc Surg. 2022 May;163(5):1804-1812.e5. doi: 10.1016/j.jtcvs.2020.08.067. Epub 2020 Aug 25. PMID: 33059934