Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

Hwang, Ho Young; Choi, Jae Woong; Hyung-Kwan, Kim; Kim, Kyung-Hwan; Kim, Ki-Bong; Ahn, Hyuk

doi:10.1016/j.athoracsur.2015.03.104

Cited by 51 publications

(48 citation statements)

References 11 publications

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“…This association was evident in our cohort whereby both patients with residual mild PVLs had undergone at least 2 previous MVRs. The choice of direct suture repair versus repeat MVR was not a risk factor for recurrence of PVL (2,3).…”

Section: Discussionmentioning

confidence: 96%

“…The majority of late PVLs are not associated with infective endocarditis (IE) (2). Accordingly, none of our patients had clinically or microbiologically proven IE, thus suggesting a different cause of their PVLs.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to conservative management, surgical repair has been shown to relieve symptoms, decrease the need for blood transfusion and improve survival (1). Hwang and associates (2) reported that 74% of PVLs occur during the first postoperative year. It is extremely rare for PVLs to occur more than 20 years after MVR (1,3,5).…”

Section: Discussionmentioning

confidence: 99%

“…Most cases of PVL remain clinically silent, but patients presenting with persistent symptoms of congestive cardiac failure, haemolytic anaemia, or a combination of both may benefit from surgical repair. The majority of PVLs occur during the first postoperative year (2). It is extremely rare for patients to develop PVL decades after MVR (1).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of paravalvular leak (PVL), defined as a regurgitant jet between the prosthetic sewing ring and native tissues on transoesophageal echocardiography (TEE), occurs in 5-32% of patients following mitral valve replacement (MVR) (1,2). Most cases of PVL remain clinically silent, but patients presenting with persistent symptoms of congestive cardiac failure, haemolytic anaemia, or a combination of both may benefit from surgical repair.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

et al. 2016

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Most mitral paravalvular leaks (PVLs) occur during the first year after mitral valve replacement (MVR). This report describes the surgical management of 6 patients who developed very late mitral PVLs.The median interval between MVR and initial diagnosis of PVL was 16.5 years. All patients presented with congestive cardiac failure and haemolytic anaemia. The median EuroSCORE II was 9.5%. Two patients (33%) had failed attempts at transcatheter closure. Five patients underwent suture repair of the PVL. One patient underwent MVR after removal of the previous prosthesis. No in-hospital mortalities occurred. At latest follow-up (median 3.3 years), 5 patients (83%) were asymptomatic with no residual PVL. Haemolytic anaemia persisted in 1 patient with a mild residual PVL. PVL occurring decades after MVR is a rare but serious complication. Reoperative surgery can be performed in these high-risk patients with satisfactory early and midterm outcomes. J Thorac Dis 2016;8(9):E952-E956 jtd.amegroups.com images were available for 5 patients (Figure 1). The median EuroSCORE II was 9.5% (range: 4.0% to 42.2%). The median left ventricular ejection fraction (LVEF) was 61% (range: 55% to 67%).Two patients had undergone unsuccessful percutaneous closure of PVL, which failed due to either significant residual regurgitation or the closure device interfering with the existing mitral prosthesis. One patient who received 2 occluder devices required emergency surgery due to cardiogenic shock, resulting from a closure device being caught between the leaflets of the mitral prosthesis. Five patients with discrete PVLs in the presence of a calcified mitral annulus underwent direct suture repair without removal of the existing mitral prosthesis. One patient with multiple PVLs at various sites along the sewing ring underwent MVR after extirpation of the previous prosthetic valve. Concomitant procedures were performed in 4 patients ( Table 1). The median aortic cross-clamp and cardiopulmonary bypass times were 50 minutes (range, 42 to 119 minutes) and 99 minutes (range, 72 to 196 minutes), respectively.There were no in-hospital mortalities. Postoperative complications are listed in Table 1. No patients suffered from postoperative stroke, myocardial infarction or required insertion of a permanent pacemaker. Upon discharge from hospital, five patients (83.3%) had no residual PVL and 1 patient (16.7%) had mild residual PVL.All patients were reviewed at our institution during scheduled clinic consultations. The median follow up period was 3.3 years (range: 1.9 to 4.8 years). There were no late mortalities. Five patients (83.3%) were in NYHA class I and had no recurrence of haemolytic anaemia. Four patients (66.7%) had no recurrence of PVL and two patients (33.3%) had mild PVL during follow-up echocardiographic assessment ( Table 1). In the patient who underwent salvage surgery following failed transcatheter repair, haemolysis persisted despite surgical correction, due to a turbulent jet flowing through a mild residual PVL. The patient op...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

et al. 2016

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Paravalvular Leaks: One Size (or Shape) Doesn't Always Fit All?

Paixao

Çilingiroğlu

2016

Cathet Cardio Intervent

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Cardiac prostheses‐related hemolytic anemia

Alkhouli

Farooq

et al. 2019

Clinical Cardiology

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Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis‐related hemolysis.

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Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

Abstract: Major PVL without obvious infection occurs even 20 years after MVR with 10- and 20-year major PVL-free rates of 96.2% and 86.9%, respectively. Occurrence of major PVL after MVR is more frequent in elderly, male patients and those who undergo redo MVR.

Cited by 51 publications

References 11 publications

Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

Paravalvular Leaks: One Size (or Shape) Doesn't Always Fit All?

Cardiac prostheses‐related hemolytic anemia

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