Second crossclamp to perfect degenerative mitral valve repair: Decision-making algorithm, safety, and outcomes

Ahmed El-Eshmawi*, Anelechi Anyanwu, Percy Boateng, Amit Pawale, Dimosthenis Pandis, Himani V. Bhatt, Erick Sun, David H. Adams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: Residual mitral regurgitation reduces the efficacy of mitral repair and is associated with worse outcomes. We adopted a policy using a second bypass run for patients with residual mitral regurgitation (>+1) and described our decision-making algorithm and outcomes. Methods: From January 1, 2011, to December 31, 2016, 40 patients with degenerative disease underwent a second bypass run to address residual mitral regurgitation. The echocardiographic criteria for a second bypass run was the presence of moderate or greater mitral regurgitation or mild mitral regurgitation with unfavorable mechanism. Results: A second bypass run was used in 40 patients. The mean age was 57.3 ± 13.5 years (21-79 years), and 14 patients (35%) were asymptomatic. Residual mitral regurgitation was mild in 25 patients, moderate in 9 patients, and moderate/severe in 6 patients. The cause of postbypass mitral regurgitation was technical or residual pathology in 35 patients and systolic anterior motion in 5 patients. Re-repair techniques were cleft closure in 22 patients, primary suture repair in 13 patients, and expanded polytetrafluoroethylene chordoplasty in 9 patients. After re-repair, 34 patients (85%) had no mitral regurgitation, 4 patients (10%) had trace mitral regurgitation, and 2 patients (5%) had mild mitral regurgitation. Median total cardiopulmonary bypass time was 208.5 minutes, first crossclamp time was 106 minutes, and second crossclamp time was 34 ± 12 minutes. Median intensive care stay was 2 days, and hospital stay was 8 days. On discharge, there was no mitral regurgitation in 13 patients (33%), trace in 23 patients (58%), and mild mitral regurgitation in 4 patients (10%). Freedom from moderate or greater mitral regurgitation at 5 years was 100%. Conclusions: Residual mitral regurgitation can be effectively treated using a second bypass run with good long-term outcome and minimal incremental risk.

Original languageEnglish (US)
Pages (from-to)1181-1190
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number5
StatePublished - Nov 2020


  • degenerative mitral disease
  • mitral regurgitation
  • mitral repair
  • residual mitral regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery


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