c  2008 Wiley Periodicals, Inc. 415 ORIGINAL ARTICLES Mitral Valve Replacements in Redo Patients with Previous Mitral Valve Procedures: Mid-Term Results and Risk Factors for Survival Tankut Hakki Akay, M.D., Bahadir Gultekin, M.D., S ¨ uleyman Ozkan, M.D., Erdal Aslim, M.D., Emrah Uguz, M.D., Atilla Sezgin, M.D., and Sait Aslamaci, M.D. Faculty of Medicine, Department of Cardiovascular Surgery, Baskent University, Ankara, Turkey ABSTRACT Objective: We aimed to investigate the risk factors for hospital mortality, short (five years) and mid- term (10 years) survival in patients who underwent mitral valve replacements in redo patients with previous mitral valve procedures. Patients and Methods: Between September 1989 and December 2003, 62 redo patients have undergone mitral valve replacements due to subsequent mitral valve problems. Preoperative, operative, and postoperative data were analyzed retrospectively and evaluated for risk factors affecting hospital mortality, mid- and long-term survival. Results: The hospital mortality was 6.4%. The one-, five-, and 10-year actuarial survival rates were 94% ± 2%, 89% ± 6%, and 81 ± 9%. New York Heart Association (NYHA) functional class IV, low left ventricular ejection fraction (<35%), increased left ventricular end-diastolic diameter (LVEDD) > 50 mm, female gender, pulmonary edema, and urgent operations were found to be risk factors in short-term survival. NYHA functional class IV, low left ventricular ejection fraction, increased LVEDD, and increased left atrial diameter (LA > 60 mm) were risk factors in mid-term survival. Conclusion: Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery. doi: 10.1111/j.1540-8191.2008.00630.x (J Card Surg 2008;23:415-421) Despite the change in the spectrum of valvular op- erations, surgical treatment of valvular diseases still has a great importance. Prosthetic valve replacement forms a serious percentage of these valvular opera- tions. Long-term results of mitral plasty operations are encouraging. However, cases requiring reoperation due to deformation of mitral valve are increasing. Besides, a perfectly functioning ideal prosthetic valve is still not present. The most important complication is the dys- function of the prosthetic valve. Despite the surgical improvement and increased success rate of prosthetic valve re-replacements, 1 some risk factors are still pos- ing a challenge for the surgical teams. 2-5 Therefore, un- derstanding the risk factors that affect the short- and mid-term survival after re-replacement of prosthetic valves has vital importance. We investigated the risk Funding: The study was performed only in Baskent University Faculty of Medicine and there was no external financial support. Address for correspondence: Tankut Hakki Akay, M.D., C ¸ ankaya PTT PK-56 C ¸ ankaya Ankara 06552/Turkey. Fax: +90-312-2123174; e-mail: tankutakay@gmail.com factors for hospital mortality (early mortality at 30 days) and short- (five years) and mid-term (10 years) survival in patients who underwent re-replacement for pros- thetic mitral valve dysfunction. PATIENTS AND METHODS Between September 1989 and December 2003, 1299 patients underwent valvular operations in our clinic. During this period, 62 patients were reoperated and had mitral valve replacements (4.7% of all valve operations) due to subsequent mitral valve problems. Prior mitral valve replacements, commissurotomies, and valvuloplastic procedures were considered as first operations. Patients with congenital valve disorders who were 15 years or younger at reoperation were excluded. Concomitant procedures (other valve opera- tions and/or coronary revascularizations) were included in this study. Statistical analysis was including only the patients who underwent re-replacement for the first time. Patients who underwent paravalvular leak repair,