Reoperation in patients with a bioprosthesis in the mitral position: indications and early results.

Our experience with 221 patients undergoing a first reoperation for bioprosthesis failure in the mitral position is reviewed. Most, (196, 89%) were reoperated because of structural valve deterioration, 16 (7%) had periprosthetic leak and nine (4%) had prosthetic endocarditis. Operative mortality (23 patients overall, 10.4%) was significantly higher in those patients who were in NYHA functional class IV or had impaired left ventricular function, in those reoperated because of prosthetic endocarditis and those undergoing emergency reoperation. Those patients who had structural valve deterioration, good left ventricular function and who were reoperated electively had the lowest operative risk. With increasing experience and the use of standardized surgical techniques, the results of reoperation for bioprosthetic failure have improved considerably in recent years. A further reduction in operative risk can be expected with better patient selection, obtained through more careful non-invasive assessment of valve performance to detect the initial signs of bioprosthetic failure.