Abstract 14849: Primary Mechanisms of Early Valve Failure Are Accurately Identified by 3D Echocardiography With Excellent Results for Early Re-Repair If Dehisced Sutures or Leaflet Tears Identified

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A14849-A14849
• Main Authors: Shigemitsu, Sachie, Zahari, Norazah, Beigh, Mirza, Silmi, Amal, Moray, Amol, Lin, Lily, Colen, Timothy M, Jonker, Viljee, Freed, Darren H, Rebeyka, Ivan M, Ross, David, Al-Aklabi, Mohammed, Khoo, Nee S
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.14849

IntroductionThe early return to surgery to re-repair (≤30 days after initial repair) of a left atrioventricular valve (LAVV) or mitral valve (MV) for early valve failure (EVF, ≥ moderate regurgitation) is a difficult decision with guarded results. This study examines features identified on three-dimensional echocardiography (3DE) associated with successful re-repair.MethodsCase series of 227 consecutive patients who underwent initial LAVV repair (19 pAVSD, 133 cAVSD, 74 MV) from 2006 to 2019 with EVF. Post op 2DE and 3DE were reviewed for mechanism of EVF, compared with surgical findings and outcome.Results59 patients had EVF [9 pAVSD (47% of pAVSD), 33 cAVSD (25% of cAVSD), 17 MV (23% of MV)]. 17 patients underwent early re-repair (≤ 30 days) due to intractable heart failure or repairable mechanisms identified by 3DE, and 42 patients did not have early re-repair. Clinical 3DE was performed in 18 patients (10 of 17 from early re-repair group and 8 of 42 from no re-repair group). Of the early re-repair group, 3DE identified repairable mechanisms in 6 (2 dehisced patch/sutures, 4 leaflet tears) with excellent outcomes - 5 post re-repair regurgitation ≤ mild and 1 mitral valve replacement (MVR) in 22yr old. The other 4 patients EVF due to abnormal valve tissue had poor outcomes - 3 severe post re-repair regurgitation and 1 MVR in 8yr old. In the no re-repair group, 3DE identified EVF mechanism in 6 as primarily abnormal valve tissue, 3 had late re-repair (> 30 days) that resulted in 2 MVR and 1 mild regurgitation post repair; while 2 had repairable mechanism, both required late re-repair (>30 days) with post re-repair mild/mod regurgitation. Comparing 3DE to surgical findings demonstrated agreement in 13 of 15 (87%) for primary mechanism.ConclusionEarly re-repair of early valve failure has excellent results when the primary mechanisms of failure are dehisced patch/sutures or leaflet tears. 3DE is highly accurate in distinguishing repairable vs. unrepairable mechanism of EVF.