mortality. In the current era transcatheter aortic valve implantation (TAVI) is becoming an increasingly viable option particularly for the higher risk redo operations. This study thus sought to review the surgical outcomes for a contemporary cohort of AVR after previous cardiac surgery. Methods: 113 consecutive patients receiving aortic valve replacement following previous cardiac surgery between 2003 and 2013 at the Prince of Wales Hospital. Data was recorded prospectively and stored in the department data- base. The mean logistic EUROscore was 33.97  22.9, mean age 69.1  13.2 years. Results: Isolated AVR was performed in 63 (55.8%), AVR + CABG in 47 (41.6%), and AVR + AF surgery in 3 (2.7%). First time reoperation occurred in 107 (94.7%), second time redo in 5 (4.4%), and third in one. Seventy patients (61.9%) had previous CABG, while 44 (38.9%) had had a previous AVR, and 8 (7.1%) patients had other previous cardiac sur- gery. There were 5 in-hospital deaths (4.4%). Post-operative complications included: renal failure requiring dialysis in 5 (4.4%), myocardial infarction in 3 (2.7%) and stroke in 1 (0.9%). Mean ventilation time was 23.5  23.2 hours, ICU stay was 3.6  5.1 days, hospital stay was 19.3  13.2 days. Conclusion: With the advent of TAVI for higher risk patients it is imperative that we ascertain the operative risk for redo cardiac surgery in a contemporary cohort. We have shown that these high risk patients can undergo redo surgery for AVR with an acceptable surgical risk. http://dx.doi.org/10.1016/j.hlc.2014.12.048 Mitral valve repair or bioprosthetic replacement: The conundrum in Indigenous rheumatic mitral disease G. Crouch * , A. Main, G. Rice, R. Baker, J. Bennetts Department of Cardiothoracic Surgery - Flinders Medical Centre, Bedford Park, Australia * Corresponding author. Introduction: Rheumatic heart disease remains endemic in the Aboriginal Australian population despite improvements in prevention and early treatment, often requiring surgery at an early age. Whilst valve repair is now standard for myxo- matous mitral disease, replacement forms the standard of care for rheumatic patients across Australia. Indigenous Australian patients are frequently not candidates for warfa- rin therapy and therefore unsuitable for a mechanical pros- thesis, due to a combination of social, cultural and education factors including age, contact sport, future pregnancy, com- pliance, and access to medical care. Our hypothesis was that repair of the rheumatic valves would offer equivalent, if not greater longevity than bioprosthetic replacement. Methods: A retrospective analysis of prospectively col- lected data was conducted including all patients undergoing mitral repair or bioprosthetic replacement with a pathologi- cal diagnosis of rheumatic disease. Patients’ preoperative and hospital stay data was retrieved from the institutional database and crosschecked against referrer records. Post- discharge data was collected from the Northern Territory cardiology database including echocardiography. Results: A total of 129 Indigenous Australians requiring mitral valve surgery from 1998 to 2013 were included (59 repair, 70 replacement). Mean ages were 29.912.4 years and 32.914.1 years for repair and replacement respectively. EuroSCORE was similar between groups (p=NS), as was pre- operative LV function (577% repair vs 5525% replace, p=NS). Thirty-day mortality was similar (1.7% repairs vs 2.9% replace, p=NS), as was stroke (0% vs 1.4%, p=NS). Late mortality was similar between groups (8.6% repair vs 8.5% replace, p=NS). Freedom from reoperation at a mean period of follow-up of 6347 months (replacements) and 5537 months (repairs, p=0.17) was 77.1% and 79.7% respectively (p=NS). Combined death and freedom from reoperation was also similar (29.3% replacements vs 30.9% repairs, p=0.89). There were however differences in echocardiographic follow-up. Freedom from moderate or greater mitral stenosis at a mean period of 5047 months (replace) and 4532 months (repair, p=0.23) was 43.9% and 67.3% respectively (p=0.02). Freedom from moderate or greater mitral regurgitation also favoured replacements (95.3% replace vs 49.1% repair, p <0.01). Discussion: The treatment of rheumatic mitral disease in the often young and remote Indigenous population remains challenging. When considering death and freedom from reoperation there is no difference between treatment with repair or bioprostheses. However echocardiographic param- eters strongly favour bioprosthetic replacement over repair. When considering these findings it must be noted that not all rheumatic valves are repairable, and rheumatic repair is an evoloving technique and death and reoperation may become different over time. http://dx.doi.org/10.1016/j.hlc.2014.12.049 Percutaneous mitral valve repair in a high-risk Australian series J.J. Edelman *1 , P. Dias 2 , E. Yamen 2 , J. Passage 1 1 Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia 2 Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia * Corresponding author. Background: The prognosis for patients with symptom- atic, severe mitral regurgitation (MR) who have comorbid- ities precluding mitral valve surgery is poor. Treatment of MR using a percutaneous edge-to-edge technique may improve survival, quality of life and reduce hospitalisations. To date, there are few studies reporting outcomes after per- cutaneous mitral valve repair in high-risk patients and none reported from Australia. Methods: The first 25 patients undergoing percutaneous mitral valve repair using the Mitraclip in our institution had follow-up to 6 months. These patients had severe, symptom- atic MR and were deemed too high-risk for mitral valve surgery by a multidisciplinary heart team, including an interventional cardiologist and cardiothoracic surgeon. Results: There were no peri-procedural deaths; the only peri-procedural morbidity was blood transfusion in 3 patients. Three patients had died at 6 months and there were 6 read- missions to hospital. There was a significant improvement in heart failure symptoms, 6 minute walk test and quality of life at 6 months. There was a significant improvement in the proportion of patients with MR 2+, but no significant change in other echocardiographic parameters. e22 Abstracts