JUAN CRESTANELLO: Welcome to the Cardiovascular Surgery series where we'll review the latest research in cardiovascular surgery from the Mayo Clinic in just two minutes. My name is Juan Crestanello. I am a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota. We will discuss today mitral valve repair versus replacement in patients with previous mediastinal irradiation.

This article was published in the seminars in thoracic and cardiovascular surgery in September 2021. The outcomes of mitral valve surgery in patients with previous mediastinal radiation have not been well characterized. In this article, we analyze the long-term survival in 148 patients who had mitral valve repair or replacement after mediastinal irradiation.

After propensity matching for baseline and surgical characteristics, we found that long-term survival was not different between repair and replacement. We also found that the survival was inferior to the expected survival of an age and sex match population. We conclude that mediastinal radiation negatively affects long-term survival and that the traditional advantage of mitral valve repair over replacement or long-term survival was not seen in patients with radiation-associated mitral valve disease.

These results impact the choice of the technique to address mitral valve disease in patients with previous mediastinal radiation. Surgeons should consider, number one, the lack of survival advantage of mitral valve repair; and two, the limited life expectancy of these patients who are unlikely to outlive a bioprosthesis. Thank you for listening to the Mayo Clinic Cardiovascular Surgery series.