Doctor Q&A: “What Are Patient Outcomes For Mitral Valve Re-Repairs?” asks Sharon

According to The Journal of Thoracic and Cardiovascular Surgery, mitral valve repair is the preferred treatment to correct mitral regurgitation. Compared to mitral valve replacement, a repair has lower risk of operative mortality, preserves left ventricular function, and reduces the risk of blood clots, endocarditis, and bleeding related to lifetime anticoagulation therapy.

Unfortunately, patients who undergo mitral valve repair surgery may require re-repair. Failure of the initial repair can result from problems with the original procedure or continued degenerative disease of the valve. Regardless of the reasons for repair failure, when patients need to return to the operating room for re-repair, they want assurance that it will succeed.

To this point, we received a patient question from Sharon, who asked, “Is anyone keeping data specifically about the durability of valve re-repairs after a repair has failed? If so, what are the outcomes?” To answer Sharon’s question,  I met with Dr. Sabet Hashim, the Chairman of Cardiac Surgery at Hartford Healthcare in Hartford, Connecticut, who specializes in mitral valve repair.

Key Learnings About Mitral Valve Re-Repair Outcomes

• Dr. Hashim was not aware of specific research about the long-term outcomes of mitral valve re-repair operations. However, he did note that approximately 5% of first time mitral valve repairs may fail. Dr. Hashim said, “I don’t have data on the longevity of re-repair, but if I were to think conceptually about this issue, millions of patients have myxomatous valve disease and they have what we call prolapse. Only five percent of them develop mitral regurgitation leading to surgery.”
• Dr. Hashim suggested that it is appropriate to predict a similar outcome for mitral valve re-repairs compared to first-time mitral valve repair procedures. “When we operate on the patient, we are removing the active defect in the valve that caused the regurgitation but we are keeping the patient with myxomatous valve disease,” Dr. Hashim said. “So we can predict five percent of them will recur. So when we operate on those patients, we can apply the same rule.”
• According to Dr. Hashim, patients should actively pursue a mitral valve re-repair procedure compared to a mitral valve replacement operation. Dr. Hashim told us. “The prognosis of a re-repair is far better than the prognosis of any replacement for the patient.”

Thank you, Dr. Hashim and Hartford Healthcare!

On behalf of patients at HeartValveSurgery.com and patients across the world, thank you, Dr. Hashim, for sharing your thoughts on how re-repairs can help patients with a durable, lasting mitral valve. And thank you for everything you and your team are doing at Hartford Healthcare.

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Keep on tickin!
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, I have provided a transcript of this interview with Dr. Hashim below.