Morbidity and mortality of a failed attempt at mitral valve repair converted to replacement at the same operation.

Background And Aim Of The Study: Although mitral valve repair (MVRpr) is the preferred operation for mitral disease worldwide, some surgeons are reluctant to attempt this, believing that excess morbidity and mortality will result if the attempt fails and conversion to mitral valve replacement (MVR) is necessary during surgery.

Methods: Typical preoperative, operative and postoperative parameters were reviewed retrospectively on 2,017 consecutive adults undergoing mitral valve operations (MVO), with and without additional cardiac surgery, between 1986 and 1999. Morbidity and mortality were compared for all MVRpr, MVR and attempted repairs, which failed and were converted to replacement at the same operation (FRpr).

Results: Although cross-clamp and extracorporeal pump times were longer for FRpr than for MVRpr and MVR, neither blood product use, morbidity, nor length of ICU or hospital stay was increased. Perioperative myocardial infarction was higher in FRpr, but less than 5%. Although operative mortality was lower for successful MVRpr compared with MVR, there was no difference between FRpr and either MVRpr or MVR, whether as an isolated or combined procedure. The addition of other cardiac procedures to a specific MVO appeared to be the important variable in mortality in all the groups, rather than the length of cross-clamp or extracorporeal pump times.

Conclusion: An attempted MVRpr which fails and is converted to replacement at the same operation does not appear to be associated with excess morbidity or mortality, despite longer cross-clamp and pump times. Accordingly, MVRpr can be safely undertaken when indicated, even with additional cardiac procedures.