Mitral Valve Re-Repair After Failed Primary Repair: An Individual Patient Data Meta Analysis

All articles of this category (opens in new window) Background: Failed primary mitral valve repair (MVr) is increasingly observed as the number of procedures rises. Growing experience and emerging evidence suggest that, when technically feasible, re-repair should be actively considered. To better understand its outcomes, we performed an up-to-date meta-analysis of the available evidence. Methods: A comprehensive literature search was conducted to identify studies reporting outcomes of reoperation after failed primary MVr, published up to July 2025. An individual patient data meta-analysis was performed by extracting and digitizing relevant data from the included studies. The primary outcome was overall survival compared with valve replacement. Secondary outcomes included freedom from a third reoperation and freedom from moderate or greater mitral regurgitation. Results: A total of nine studies from eight centers were included in the analysis, comprising 341 patients who underwent re-repair and 799 patients who underwent valve replacement. Ten-year survival was significantly higher in the re-repair group compared with the replacement group (78.3% vs. 58.3%; HR: 2.44, 95% CI: [1.79–3.33], p < 0.001). Regarding freedom from reoperation, patients who underwent re-repair had lower freedom from a third mitral reoperation compared with those who received valve replacement (84.7% vs. 96.5%, p = 0.003). At 8 years of follow-up, freedom from moderate or greater mitral regurgitation in the re-repair group was 64.9 ± 7%. Conclusion: Mitral valve re-repair after failed primary MVr is safe and durable when technically feasible, offering favorable survival and preservation of native valve function. The mode and timing of repair failure largely guide the decision-making process. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany