Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period

Abstract

Background: Mitral para-prosthetic leaks are rare but major complications of mitral heart valve replacements. When they must be re-operated, they are burdened with high mortality rates. We proposed to review our surgical experience in terms of approach and type of operation carried out.Methods: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify the risk factors of postoperative mortality. We then compared the data depending on the approach and the type of surgical treatment in order to compare the morbidity-mortality.Results: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney failure were significantly more common in the decease population. Direct mitral paravalvular leak su-turing was more frequently performed on early apparition, anterior and isolated leaks, whereas a mi-tral heart valve replacement was most often performed to cure active primary endocarditis. The inci-dence of complications and mortality rates were identical according to the approach and the type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the cases.Conclusion: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered in those patients.

Mitral Para-valvular leakage following usage of non-pledgeted compared to Teflon-pledgeted sutures

“…Although incidence of PVL was higher among patients with non-pledgeted technique (6.1%) than in the pledgeted technique group (1.96%), it was statistically insignificant. This is comparable to results showed by Kim et al (12) and Dziubek et al (16).…”

Current Devices and Complications Related to Transcatheter Mitral Valve Replacement: The Bumpy Road to the Top

“…Due to the high mortality associated with surgical PVL closure, transcatheter PVL closure emerged as a safe and effective procedure. Today, the operator has the opportunity of using multiple devices concurrently, achieving outstanding results, and eliminating this common and serious complication (102)(103)(104)(105)(106).…”

“Valve-On-Valve” — an alternative method of surgical treatment of tissue valve dysfunctions

“…Наряду с этим репротезирование клапана стандартным путем при полном удалении не функционирующего БП может создать предпосылки для формирования парапротезных фистул из-за геометрического несоответствия склеротически измененного, кальцифицированного и вследствие этого деформированного нативного фиброзного кольца и манжеты имплантируемого устройства. В свою очередь по литературным данным 1-2% парапротезных фистул требуют повторного вмешательства, летальность при котором может достигать от 3,7 до 22% [32].…”

“…В продолжение настоящей темы следует отметить, что по литературным данным средние сроки наблюдения технологии "valve-on-valve" в отдаленном периоде не превысили 60-98 мес. [33,35] и в большей части публикаций были не более 1-3 лет [21][22][23][24][25][26][27][28][29][30][31][32][33][34], а также малое количество наблюдений (n=100) -всё это на сегодняшний день не позволяет получить всеобъемлющее представление о выживаемости и отсутствии нелетальных осложнений у данной категории реципиентов преимущественно МП. Также пока ещё отсутствуют предпосылки получить ответ на вопрос: "Как будет развиваться дисфункция БП, имплантированного в каркас другого клапана?".…”