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Page 10 of 20 Nappi et al. Vessel Plus 2021;5:40 https://dx.doi.org/10.20517/2574-1209.2021.06

Figure 1. Analysis of the best approach based on the characteristics of the patient and the type of failure of the first surgical approach.
CABG: Coronary artery bypass grafting; TI: tricuspid insufficiency; PAD: peripheral artery disease.

Another critical question is: “should the mitral valve be re-repaired or replaced”?

A 2006 retrospective review of patients undergoing surgical correction (repair or replacement) of recurrent
MV regurgitation after primary MV repair for regurgitation caused by degenerative valve prolapse analyzed
[22]
145 patients who underwent mitral reoperations for recurrent MR at the Mayo Clinic, Rochester . This
review showed that there were no striking differences, in terms of operative mortality, between the re-repair
group and the replacement group, and that three different independent factors were associated with
improved survival: MV re-repair, younger age and the preoperative indication of pure MR.

These data emphasize the importance of a prior evaluation of the patient’s characteristics and the prior
mitral repair failure mechanism for the choice between a re-repair approach, when this is feasible and safe,
or replacement. The great advantage of a surgical approach is the possibility to carry out, in young and
selected patients, a lasting and probably definitive repair of the mitral valve. Our review shows that there is a
better outcome in term of survival at 5 years for patients treated with a re-repair surgery (76%) compared to
patients treated with replacement (60%).

The literature recommends that, when the repair failure is correlated to a valvular disease progression, it is
advisable to prefer a replacement to avoid a third MV surgery [14,22,25,31] [Table 4].