Background: RIFB may become necessary during DVR in the presence of complex pathology. This study is an analysis to evaluate clinical outcomes on patients after RIFB.
Methods: From 1985 to 2002, 82 consecutive patients underwent RIFB and DVR. Additional procedures were: circumferential reconstruction of the mitral annulus in 27 patients, tricuspid valve repair in 21, CABG in 16, and aortic root replacement in 5. Indications for the operation were active infective endocarditis with abscess in 17 patients, extensive calcification of the mitral annulus in 25, lack of fibrous tissue to secure a prosthetic valve in 17, and to treat patient-prosthesis mismatch in 23. There were 40 males. Mean age was 58 ± 12 years. Fifty-eight patients (71%) had one or more previous valve operations. Fifty-five patients were in NYHA class IV. The longest follow-up was 13.5 years with a mean of 47 ± 47 months.
Results: There were 10 operative (12%) and 18 late deaths (33%). Survival at 10 years was 47%, and freedom from reoperation was 67%. Ten patients required redo RIFB and DVR: 8 for prosthetic valve endocarditis (6 early) and 2 for patch/valve dehiscence. Freedom from valve-related morbidity was 62% at 10 years.
Conclusions: RIFB during DVR is a useful operative technique for patients with complex heart valve pathology. Measures to reduce the risk of early prosthetic valve endocarditis are needed to improve the outcomes.

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