The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement: an observational study

Abstract

Objective: A relation between the location of the paravalvular leakage (PVL) and time to reoperation after mitral mechanical valve replacement was investigated. Methods: In an observational retrospective study plan, from 59 patients who underwent reoperation only 47 patients having clinical and echocardiographic follow-up for five years were included into study. Depending on echocardiographic evaluation of location of leak, patients were divided into Group 1 (Leaflet) and Group 2 (Commissural). Demographics, preoperative variables, causes of reoperation, the time period between diagnosis of PVL and reoperation were recorded. Unpaired t test or Mann-Whitney U test were used for comparison of variables between groups. Results: A PVL was diagnosed after a median time of 180 days (range: 1 day-28 years) after the first mitral valve replacement. The median followup period was 5 years (range; 1-16 years). Age, gender, left ventricular ejection function, number and size of leaks did not differ between groups (p>0.05). The time period between diagnosis and reoperation time was longer in Group 1 in comparison to Group 2 (39.0±9.9 vs. 19.5±12.8 months, p=0.002). The 30-day mortality for valve reoperation was 4.3% (2/47). In Group 1, 2 patients (2/21, 9.8%) died whereas, no death was observed in Group 2 (0/26, 0%) (p=0.002). Conclusion:The time period between diagnosis and reoperation was longer in leaflet leak group in comparison to commissural leak group. We suggest echocardiographic evaluation should include location of the paravalvular leakage during follow-up of patients with PVL after mitral valve replacement. (Anadolu Kardiyol Derg 2014; 14: 61-7)

Early paravalvular leak after conventional mitral valve replacement: A single‐center analysis

“…Although we observed a higher rate of early PVL in patients with mitral annular calcification, this correlation did not reach statistical significance in multivariable analysis. Notwithstanding, as also advocated by Yanartas et al, 10 we suggest that MV annulus calcifications should be completely removed, whenever feasible, at the time of surgery otherwise the residual calcium can cause a reason for the development of early PVL after MVR. Dhasmana and colleagues revealed the suture technique to be associated with a high incidence of mitral PVL 8 .…”

Percutaneous Transapical Closure of Cardiac Apex and Mitral Prosthetic Paravalvular Leak is Feasible and Alternative Approach to the Surgery

“…Catheter-based closure of a paravalvular leak as a possible alternative to the conventional operation should be reserved for older and sicker patients because of higher incidence of mild/moderate paravalvular leak after the procedure. As an alternative therapy, transcatheter closure has been developed for paravalvular leak following surgical mitral valve replacement with reasonable, safe and feasible results [1][2][3][4][5].…”