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At least 271 records · Page 15Linked to original sources

PubMed2002

Reoperation for renal hyperparathyroidism.

Reoperation for secondary hyperparathyroidism (HPT) due to uremia (2HPT) may be required among patients with persistent renal failure if not all parathyroid glands are removed at the initial operation. Between March 1981 and July 2001, altogether 1,110 patients underwent total parathyroidectomy with forearm autograft for advanced 2HPT in our department. In this study, we evaluated the clinical features of patients who required reoperation and classified them into persistent HPT [the lowest intact parathyroid (PTH) level after initial operation remained higher than 60 pg/ml] and recurrent HPT (the lowest intact PTH level was normalized after surgery but reelevated became high enough to require reoperation). Removal of residual glands was indicated in 30 (2.7%) cases for persistent or recurrent HPT. All remaining glands were detected by preoperative imaging diagnoses. In 44 (4.0%) patients persistent HPT was recognized and in 15 of them (1.4% of all cases) reoperation was required. In 11 cases, the responsible glands were supernumerary ones removed from the mediastinum. In 4 cases, the glands were resected from the neck. In 15 cases (1.4%), reoperation was performed for recurrent HPT when residual glands were left either in the neck or in the thymic tongue. In all but one case, the missed glands were supernumerary. This study reveals that it is often difficult to avoid persistent HPT induced by mediastinal supernumerary glands and recurrent HPT caused by small glands left in the neck. Our findings indicate that patients with uremia should be closely followed considering the possibility that persistent or recurrent HPT may occur after parathyroidectomy.

Adult↗

PubMed2005

Complications and reoperations in stapled anopexy: learning by doing.

Although stapled anopexy for second and third degree hemorrhoids has been widely used since 1998, there are limited long-term data available. We performed an analysis of a prospectively accrued data set of all patients undergoing stapled anopexy in our practice from 1998 through August 2003. Patients were specifically assessed for early and late complications and long-term reoperation rates for anorectal pathology. We performed stapled anopexy in 654 patients (296 females) during the study period. Mean operation time was 21 min (5-70 min), and the postoperative stay was 3.6 days (1-13 days). Early postoperative complications: urinary retention, 42 patients (6.4%); fecal impaction, 18 (2.8%); postoperative hemorrhage, 26 (4.0%); thrombosed external hemorrhoid, four (0.6%); and fistula/abscess, nine (1.4%). Late postoperative complications: anastomotic dehiscence, 21 patients (3.2%); persistence of prolapse in three (0.5%); submucosal anastomotic cysts in four (0.6%); thrombosed external hemorrhoid in two (0.3%); skin tags in ten (1.5%); fissure in six (0.9%); proctitis in two (0.3%); and fecal incontinence in ten (1.5%). Reoperation was required in 50 patients (7.6%). Reoperation for complications within 30 days occurred in 42 patients (6.4%) for the following reasons: bleeding (23), dehiscence (five), thrombosed external hemorrhoid (three), fecal retention (two), fistula (three), fissure (five), and anal papilla (one). Reoperation for anorectal pathology after 30 days was required in 54 patients (8.3%) and was performed for the following: dehiscence/reprolapse (17), stenosis (two), submucous cyst (two), fistula (four), fissure (six), anal papilla (four), skin tags (five), persistent anal itching (five), and miscellaneous (seven). These data represent the largest series of patients with long-term follow-up following stapled anopexy and confirm that the operation is safe in experienced hands using appropriate patient selection. The early complication rate is low and similar to rates reported for excisional hemorrhoidectomy. Importantly, the procedure is associated with a low 3.4% rate of reoperation for persistence or recurrence of hemorrhoidal prolapse with good patient selection.

Adult↗

PubMed2006

The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation.

PURPOSE: Local excision of early rectal cancer is a controversial issue, which is in part because of differences in the evaluation of histopathologic criteria. This prospective study was designed to determine prognostic factors for recurrences and the need for reoperation. METHODS: In 105 of 118 patients with pT1 carcinomas and local excision, results of recurrence rates and ten-year cancer-free survival were studied separately according to different histologic criteria (R0, R1, Rx, R < or = 1 mm, high-/low-risk situation), tumor localization (anterior, posterior, lateral wall and third of rectum), size, and degree of resection (full-thickness/partial wall). Patients were grouped into local excision (n = 89) and local excision followed by reoperation (n = 21). Risk classification was performed by division into "low-risk" carcinomas after local R0-resection (Group A) and unfavorable histologic results after local resection (R1, Rx, R < or = 1 mm, high-risk situation; Group B). RESULTS: Local recurrence rates after local R0-resection of low-risk carcinomas were 6 percent, whereas patients in Group B with local resection were 39 percent. The recurrence risk in those patients was significantly reduced to 6 percent by reoperation (P = 0.015). In addition, ten-year, cancer-free survival was 93 percent in Group B after reoperation compared with 89 percent in patients of Group A after local excision alone. CONCLUSIONS: Local R0-resection in cases with low-risk pT1 carcinomas represents an oncologically adequate therapy, which results in similar survival rates compared with primary radical surgery of pT1N0M0 rectal carcinomas. High recurrence rates are observed in tumors with unfavorable histologic result (Group B) requiring further treatment. In these cases immediate reoperation reduces the recurrence rate to 6 percent.

Adult↗

PubMed1986

Clinical results of reoperation after failed highly selective vagotomy.

The results after reoperation after failed highly selective vagotomy during a 10 year period have been reviewed retrospectively. Forty of 306 patients (13 percent) underwent reoperation due to recurrent ulcer (25 patients), severe dyspepsia without proved recurrence (12 patients), and gastric stasis without recurrence (3 patients). In the first two groups, 16 patients had a second vagotomy and 17 underwent partial gastrectomy, 10 with gastroduodenostomy and 7 with gastrojejunostomy. The need for a second reoperation was disquietingly high after both revagotomy (5 of 16 patients) and partial gastrectomy with gastroduodenostomy (4 of 10 patients). These results contrasted with a successful outcome in all seven patients who underwent reoperation with partial gastrectomy and gastrojejunostomy. At the time of follow-up, 85 percent of the reoperated patients (34 of 40 patients) were in Visick grade 1 or 2 as determined by their own judgement.

Dyspepsia↗

PubMed1990

Reoperations on heart valve prostheses: an analysis of operative risks and late results.

To evaluate risks and complications of reoperations on heart valve prostheses, we reviewed data on 183 patients who underwent reoperation because of prosthetic valve malfunction. The incremental effect of the redo procedure on hospital mortality and morbidity was studied by comparing primary and reoperative procedures and analyzing a series of possible predisposing factors. Late survival after first and second reoperations was computed, and possible determinants of late mortality were examined. Overall operative mortality was 8.7%; emergency operation (p = 0.0001), previous thromboembolism (p = 0.05), and advanced New York Heart Association functional class (p = 0.031) were the independent determinants. In a series of 1,355 patients having primary or secondary isolated valve replacement, the redo procedure was a significant risk factor in the univariate analysis (p = 0.025) but not in the multivariate analysis except for the subset of patients having mitral valve replacement (p = 0.052). The postoperative course was quite complicated, as evidenced by the long mean stay in the intensive care unit (mean stay, 3.8 days; longer than 2 days for 26% of the survivors). Nevertheless, postoperative complications were not significantly greater after a redo procedure than after a primary operation. Actuarial survival at 7 years was 57.3% +/- 8%. A comparison with a nonhomogeneous series from our institution did not demonstrate significant differences. In the subset of 16 patients having a second reoperation, late survival was 37.8% +/- 16% at 2 years. Advanced New York Heart Association class (p = 0.0001), double prosthetic valve dysfunction (p = 0.003), and any indication other than primary tissue failure (p = 0.06) were determinants of late mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioprosthesis↗

PubMed1990

Reoperation in the intensive care unit.

From July 1, 1984, through June 30, 1989, after 1,259 open heart operations, 110 patients (8.7%) underwent 162 early reoperations either in the intensive care unit (144 procedures) or in the operating room (26 procedures). Reexploration for bleeding (49 procedures) (3.9%) and intraaortic balloon removal (50 procedures) (4.0%) were the two most common procedures. Ninety percent and 96% of these procedures, respectively, were performed in the intensive care unit. Mediastinal infections occurred in 4 (6.1%) of 66 patients undergoing repeat mediastinal operations for all indications. No infection occurred after reexploration for bleeding nor did mediastinal infection occur after reoperation in the intensive care unit. Postoperative death in these 110 patients was not related to reoperation except possibly in the case of 1 patient (0.9%). Average transit time to and from the operating room for patients returned there for reoperation was 89.7 minutes. Charges for procedures performed in the operating room were at least twice as great as for those performed in the intensive care unit. This experience supports expanded use of reoperation in the intensive care unit, as it is safe, effective, economical, and convenient.

Adult↗

PubMed1994

Reoperation for complications of the Angelchik antireflux prosthesis.

The Angelchik antireflux prosthesis is associated with complications that require reoperation in 5% to 15% of patients. To determine the morbidity and success of reoperation for these complications, we conducted a retrospective study of 15 patients. Time to reoperation ranged from 3 weeks to 113 months with a mean of 31 months. Indications for reoperation included dysphagia (8 patients), recurrent reflux (6 patients), and prosthesis migration (1 patient). Ten patients underwent prosthesis removal and fundoplication, 4 had prosthesis removal without fundoplication, and 1 patient had the prosthesis repositioned. Iatrogenic splenic injury occurred in 2 patients (13%); one splenectomy and one splenic repair were done. Four patients (27%) required intraoperative blood transfusion. There were no operative deaths. Removal of the prosthesis without fundoplication resulted in a significantly higher incidence of recurrent reflux (75%) than prosthesis removal and fundoplication (10%) (p < 0.04). Although reoperation for complications of the Angelchik antireflux prosthesis can be technically difficult, morbidity and mortality are acceptable. An antireflux procedure should be done at the time of prosthesis removal.

Adult↗

PubMed2006

Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty.

The goal of this report is to review reoperations undertaken on the initial 221 unicompartmental arthroplasties performed using a minimally invasive technique. A comparison was then performed between these cases and the previous 514 open medial unicompartmental arthroplasties performed at our institution. In the minimally invasive group, 9 (4.1%) of 221 knees were revised (8 for component loosening, 1 for deep infection). Of 212 unrevised knees, 16 have required a total of 18 nonrevision reoperations. Overall, 25 of 221 knees required at least 1 reoperation (total reoperation rate, 11.3%). Despite an accelerated recovery and decreased hospital stay in our minimally invasive unicompartmental arthroplasties, the rate of revision due to aseptic loosening (3.7% vs 1.0%) and the overall reoperation rate (11.3% vs 8.6%) compare unfavorably with those performed with an open technique.

Adult↗

PubMed2006

Risk factors for early death and reoperation following biventricular repair of pulmonary atresia with intact ventricular septum.

OBJECTIVE: Since a functional right ventricle is desirable when repairing pulmonary atresia with intact ventricular septum, we sought to determine the factors that portend a successful biventricular repair in these children. METHODS: A review of operative records at UCLA between 1982 and 2001 revealed 56 patients diagnosed with pulmonary atresia with intact ventricular septum that underwent either a partial (n=26) or complete biventricular repair. Kaplan-Meier survival curves with log rank statistics were used to evaluate the influence of demographic, technical, and anatomic factors on survival and need for reoperation. RESULTS: Five-year actuarial survival following biventricular repair was 91.5%. Non-Caucasian race (p=0.011) and omission of palliative right ventricular outflow tract obstruction (RVOTO) relief (p=0.042) were risk factors for early death. All patients with adequate follow-up required reoperation with median duration of 6.9 years. The most common cause of early reoperation (<1 year) was wound infection (35.3%) while pulmonary valve replacement (58.8%) constituted the majority of late reoperations. Risk factors for wound infection included female sex (p=0.011) and use of a synthetic transannular patch (p=0.085). The most significant risk factor for early pulmonary valve replacement was the use of a monocusp pericardial valve in the pulmonary annular position (p=0.003). CONCLUSIONS: Excellent survival follows biventricular repair of pulmonary atresia with intact ventricular septum if RVOTO relief is performed in conjunction with initial palliation. Although most patients eventually require reoperation, avoidance of synthetic transannular patches and monocusp pericardial pulmonary valves may reduce the incidence of wound infection and delay need for pulmonary valve replacement.

Adolescent↗

PubMed2005

A novel adhesion barrier facilitates reoperations in complex congenital cardiac surgery.

OBJECTIVE: Reoperations are associated with an increased surgical risk due to adhesions. We prospectively evaluated a bioresorbable membrane after surgery for congenital heart defects over a 3.5-year period. METHODS: The surgical membrane (CV Seprafilm, Genzyme, Cambridge, Mass) was applied in 350 of 1024 patients; 30 of them underwent reoperation and were evaluated in comparison to 10 random reoperated patients. Adhesions were evaluated using a subjective scoring system [1 (lowest tenacity) to 5 (highest tenacity)] and extent in percent at different regions of the heart. RESULTS: Patients were operated for atrioventricular septal defect (69), tetralogy of Fallot (65), functional single ventricle (75), valve surgery (48), ventricular septal defect (20), subaortic stenosis (17), hypoplastic left heart syndrome (17), and other diagnoses (39). Application of the surgical membrane was safe in all patients, without any infections. At reoperation patients received Glenn (14), total cavopulmonary connection (6), and others (10). Overall mortality was 2/350 (0.57%). There was a remarkable reduction in tenacity score (3.3 vs 4.3) and in the extent of adhesions (77.7% vs 86%). Duration of reoperation was significantly reduced. CONCLUSIONS: A bioresorbable surgical membrane leads to a significant reduction in the tenacity and amount of adhesions. It is recommended for general use whenever repeat operation is anticipated in congenital as well as in adult cardiac surgery.

Aortic Valve Stenosis↗

PubMed1988

Reoperative carotid surgery.

Fourteen patients underwent carotid reoperation for symptomatic recurrent carotid stenosis after previous ipsilateral carotid endarterectomy. Eight of these patients presented with focal transient ischemic attacks, two with strokes, and four with vertebrobasilar insufficiency. Recurrent symptoms in eight patients were similar to those prompting the initial carotid endarterectomy. Symptoms recurred early after previous carotid endarterectomy in 2 patients and late in 12 patients. Eleven patients underwent repeat endarterectomy and carotid patch angioplasty, two patients underwent patch angioplasty alone, and one patient underwent carotid artery replacement with a vein graft. Persistent or recurrent focal symptoms referable to the reoperated carotid artery were not present during follow-up (mean 27.4 months, range 4 to 79 months). Vertebrobasilar symptoms were relieved by carotid reoperation in each patient. Although the natural history of asymptomatic postoperative carotid restenosis is unknown, reluctance to reoperate on symptomatic patients is unwarranted, since carotid reoperation can be performed safely with the expectation that recurrent focal and nonfocal vertebrobasilar symptoms will be relieved.

Aged↗

PubMed2001

Reoperation and coarctation of the aorta: the need for lifelong surveillance.

BACKGROUND: We report a series of reoperations in 23 patients who had undergone previous aortic coarctation repair. METHODS: The medical records of these patients were reviewed, and the patients were followed up by telephone interview. Mean age at reoperation was 25 years. There was a mean of 18 years between initial coarctation repair and reoperation. Indications for reoperation included recoarctation (9 patients), aortic aneurysm (8), aortobronchial fistulas with exsanguinating hemorrhage (2), subaortic stenosis (1), ruptured thoracic aneurysm (1), ruptured sinus of Valsalva aneurysm (1), and supramitral stenosing ring (1). RESULTS: There were no specific intraoperative complications. Three patients required reexploration for bleeding. An acutely ischemic lower limb developed in 1 patient secondary to a common femoral artery embolus, which necessitated embolectomy. CONCLUSIONS: Reoperation for postcoarctation repair patients can be performed with good results. Sudden life-threatening hemorrhage due to aortobronchial fistulas in patients having undergone Dacron patch aortoplasty, as well as long-term obstructive phenomena seen anywhere along the left ventricular outflow tract, make lifelong surveillance of these patients mandatory.

Adult↗

PubMed1983

Trends in selection and results of coronary artery reoperations.

The first 1,000 patients undergoing isolated coronary artery reoperation were divided into four cohorts of 250 patients each: 1969 to 1976; 1976 to 1979; 1979 to 1981; and 1981 into 1982. Graft failure as an indication for reoperation rose from 26% in Group 1 to 40% in Group 4, and the interval lengthened from 17 to 61 months, presumably a result of late closures 5 to 10 years postoperatively. Progressive atherosclerosis in previously ungrafted vessels has decreased from 62% in Group 1 to 23% in Group 4, a decline attributed to more complete revascularization initially. The frequency of three-vessel disease, stenosis of the left main coronary artery, and left ventricular impairment continues to rise in candidates for reoperation. Yet, operative mortality has declined from 5% to 2%, and most other forms of perioperative morbidity have decreased significantly when the early years are compared with the later experience. The number of grafts per patient has increased from 1.4 to 2.3, and complete revascularization in reoperations has increased from 65% to 76%. After a mean of 29 months, graft patency was 81% overall in 154 patients restudied after reoperation. Patency was similar for grafts to arteries previously involved with graft failure and to arteries not previously grafted. Five-year actuarial survival for patients in the first three cohorts (mean, 57 months) was 89%.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗

PubMed1983

Results of reoperation for periprosthetic leakage.

Between 1961 and 1978, 6,602 valves were replaced in 5,660 patients. Reoperation for periprosthetic leakage was performed in 105 patients (1.6% of the valves); early mortality was 5.7%. At reoperation, 52% of patients were in New York Heart Association Classes III and IV, whereas 72% had been in Classes III and IV prior to the primary valve replacement. Seventy-five patients had aortic periprosthetic leaks, which were distributed equally around the annulus. Among these patients, 41 (55%) had aortic valve rereplacement and 34 (45%) had suture repair. At 5 years, the survival was 94% and the event-free survival was 71%. Seventeen patients had multiple aortic valve reoperations. Hospital mortality for the second reoperation was 5.8%. At late follow-up, 19 patients had murmurs of residual or recurrent aortic periprosthetic leakage. Twenty-nine patients had mitral periprosthetic leaks, most often near the anterior leaflet. Eight patients had mitral valve rereplacement, and 21 had suture repair. At 5 years, the survival was 75% and the event-free survival was 52%. Four patients underwent multiple reoperations. At late follow-up, 5 of the 29 patients in the mitral valve group had murmurs of residual or recurrent periprosthetic leakage. One patient had tricuspid valve rereplacement. The low hospital mortality and the good late results have encouraged us to recommend an aggressive approach in the correction of periprosthetic leakage in all symptomatic and selected asymptomatic patients.

Adult↗

PubMed1999

Reoperations on the ascending aorta and aortic root: pitfalls and results in 134 patients.

BACKGROUND: This analysis was performed to evaluate the results of reoperations on the ascending aorta and aortic root. METHODS: All reoperations (n = 134) on the aortic root and ascending aorta performed between February 1981 and April 1998 were retrospectively analyzed. Indications for reintervention were a true or false aneurysm (35%), acute dissection (3.0%), aortic valve stenosis and/or insufficiency (23.1%), prosthetic valve endocarditis (32.8%), and combinations (4.5%). The principal reoperations performed were aortic root replacement (composite graft, freestyle, aortic allograft, or pulmonary autograft) in 116 patients, ascending aortic replacement in 10 patients, and closure of a false aneurysm in 5 patients. Results were analyzed using univariate statistical methods. RESULTS: Hospital mortality was 6.6% (8 patients). Univariate predictors of hospital death were preoperative functional class III or IV (p = 0.02), an interval of less than 6 months between the primary and actual operation (p = 0.02), preoperative creatinine level of more than 200 micromol/L (p = 0.001), acute aortic dissection (p = 0.001), intraoperative technical problems (p = 0.001), and postoperative dialysis (p = 0.001). Freedom from repetitive reoperation was 99% at 1 year and 98% at 5 and 10 years. CONCLUSIONS: Reoperations on the aortic root and ascending aorta can be performed with an early mortality which is very acceptable.

Adult↗

PubMed1991

Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease.

OBJECTIVE: To determine the long-term outcome after laparoscopic excision of endometriosis. DESIGN: This longitudinal unmatched study evaluated surgical outcome using follow-up questionnaires and evaluation of reoperations with results presented in life table format. SETTING: Surgery was performed by a private practitioner at a referral center. PATIENTS: All 359 patients undergoing laparoscopic excision of endometriosis between December 12, 1980, and March 31, 1990, were studied. INTERVENTIONS: Endometriosis, including deeply invasive disease, was completely excised laparoscopically using 3-mm scissors and graspers. Adjunctive medical therapy was not used. MAIN OUTCOME MEASURES: Extent of disease present at reoperation and quarterly rates of reoperation and recurrent/persistent disease are used as indicators of efficacy of surgery. RESULTS: Interval rates of reoperation and recurrence/persistence of disease and extent or invasiveness of disease when found at reoperation did not increase with the passage of time after surgery. The maximum cumulative rate of recurrent or persistent disease was 19%, achieved in the 5th postoperative year. CONCLUSION: Laparoscopic excision of endometriosis results in a low rate of minimal persistent/recurrent disease. The natural history of endometriosis after surgery suggests a rather static nature of the disease.

Endometriosis↗

PubMed1995

Reoperation on prosthetic heart values. Patient-specific estimates of in-hospital events.

Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new persisting neurologic deficit, and length of postoperative stay, a three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0.3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (90% confidence limits 4 to 13), emphasizing the wide variance in outcome events. Equations were developed to permit wide application of the results of the study for quantitatively estimating the risk of outcome events based on individual preoperative patient characteristics. These estimates should be useful for informed patient consent, considerations of prophylactic valve replacement, and cost and resource use.

Adolescent↗

PubMed1996

Reoperation after valve repair for mitral regurgitation: early and intermediate results.

To better understand late outcomes of mitral valve repair, we reviewed the cases of 49 consecutive patients who underwent reoperation between January 1974 and May 1992 for recurrent valve dysfunction after previous valvuloplasty for mitral regurgitation. There were 27 men (55%) and 22 women, with a median age of 63 years (range 20 to 84 years). Original procedures included annuloplasty and posterior leaflet repair in 15 patients (31%), annuloplasty and anterior leaflet repair in 15 (31%), commissural plication in 13 (27%), and complex bileaflet repairs in six (12%). Median time between initial mitral repair and reoperation was 2.4 years (range 2 months to 25.3 years). Indications for reoperation included recurrent severe mitral regurgitation in 34 patients (70%), hemolytic anemia from mitral regurgitation in seven (14%), mixed mitral regurgitation and stenosis in seven (14%), and isolated mitral stenosis in one (2%). Before reoperation, 36 patients were in New York Heart Association functional class III and 11 were in class IV. Initial repairs were intact at the second operation in 32 patients (65%), and the etiology of recurrent mitral regurgitation in these patients was fibrosis or calcification of the anulus or leaflets in 22 patients, newly ruptured chordae in seven, and perforated leaflets in three. The causes of mitral regurgitation in the 17 patients whose initial repair had failed included dehiscence of commissural repairs in nine patients, dehiscence of ring annuloplasty in four, and break-down of chordal or leaflet repair in four. Patients with original repairs involving the anterior leaflet had a significantly shorter time between operations (p = 0.006). In eight patients (16%), the mitral valve was repaired again; in the remaining 41 patients (84%), prosthetic replacement was performed. Operative mortality rate was 4% (two patients). All eight patients who underwent mitral valve rerepair had no mitral regurgitation, trivial regurgitation, or mild regurgitation at discharge from the hospital. Follow-up was 100% complete at a mean of 5.1 years (range 1 to 19 years). Forty-one patients (87% were in New York Heart Association functional class I or II, and survival at 5 years was 75.3%. Of the eight patients who underwent a second repair, seven had no regurgitation, trivial regurgitation, or mild regurgitation at a median of 4 years' follow-up. The low mortality associated with reoperation supports an aggressive approach toward mitral regurgitation with initial repair. A second repair can be performed in selected patients with durable results at 4 years.

Adult↗