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J Thorac Cardiovasc Surg 2006;132:1396-1397
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr A. Marc Gillinov (Cleveland, Ohio). In this excellent and very clear review, you describe the treatment for recurrent MR after a primary operation for degenerative disease or prolapse, and in your series you re-repaired nearly half of the valves. This is an important topic because although failure of a repair is uncommon, as the number of repairs increase, we will see these cases. I have 3 questions for you.

The first concerns operative technique. When you go in for a re-repair, do you generally find it necessary to take down the entire previous operation and start over, or do you use a more directed approach and fix whatever appears to be broken?

Dr Suri. Thank you, Dr Gillinov. At the time of re-repair, the pathology found by the operating surgeon influences the valvuloplasty technique used. Generally, we address the specific anatomic feature requiring correction. Additionally, we always ensure that we maintain adequate posterior annular support by anchoring a posterior annuloplasty band between the left and right fibrous trigones.

Dr Gillinov. My second question concerns any potential changes during the time frame of this study, which spans more than 3 decades. Has there recently been a greater tendency to re-repair the valves as the surgeons have gained more experience?

Dr Suri. That is a good question. There is no doubt over the course of the 35-year study that trends and techniques have evolved. In the 1990s, we benefited from the data from yourself and others using new valvuloplasty techniques for correction of AL prolapse, including the placement of artificial polytetrafluoroethylene neochordae. As the comfort level with these techniques increased, so also did the rate of MV re-repair. That said, the frequency with which one encounters a patient with a re-repairable MV is still greater than the number that currently . . . [Full Text of this Article]

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Recurrent mitral regurgitation after repair: Should the mitral valve be re-repaired?

Rakesh M. Suri, Hartzell V. Schaff, Joseph A. Dearani, Thoralf M. Sundt, III, Richard C. Daly, Charles J. Mullany, Maurice Enriquez-Sarano, and Thomas A. Orszulak
J. Thorac. Cardiovasc. Surg. 2006 132: 1390-1397. [Abstract] [Full Text] [PDF]