Background:essment of risk factors affecting early and late outcomes of reoperation for bioprosthetic mitral valve dysfunction in patients with rheumatic heart disease and analysis of long-term prognosis of such operations.

Methods: Between 1985 and 2004, we performed reoperations for bioprosthetic valve dysfunction to 104 patients (95 women, 9 men; mean age 48.5±11.3 years; range 20 to 73 years). Causes of bioprosthetic valve dysfunction were structural degeneration in 99 patients, infective endocarditis in two patients and paravalvular leak in three patients.

Results: hospital mortality was 8.7% (9 patients). Multivariate analysis showed that tricuspid repair in the first operation (p=0.03; Odds ratio 22.7, 95%CI 1.2-423.7), pulmonary hypertension (p=0.03; Odds ratio 24.8, 95%CI 1.3- 475.8), and concomitant tricuspid valve repair in the reoperation (p=0.03, Odds ratio 22.7, %95CI 1.2-423.8) were significant risk factors for early mortality. Patients with initial tricuspid disease at the first operation had worse early outcome compared to patients without tricuspid pathology (p=0.038). Late mortality was 2.9% (3 patients). No statistically significant risk factor for late mortality was identified. The ten-year survival rate was 85.6%±4.35.

Conclusion: study suggests that reoperation for bioprosthetic mitral valve dysfunction should be performed prior to development of pulmonary hypertension. Rheumatic tricuspid valve disease requiring repair at first operation and/or at reoperation has a poor effect on the early outcome of reoperation.

Keywords : Bioprosthesis; mitral valve; reoperation; tricuspid valves