Long-term results of surgical correction for mitral paravalvular leak: repair versus re-replacement

Paravalvular leak (PVL) is a common clinical manifestation after cardiac valve replacement. The results of surgical management for mitral PVL were evaluated and compared according to the surgery employed.

Between September 1995 and September 2009, a total of 52 patients (30 males, 22 females; mean age 57.2 +/- 13.0 years) underwent surgery for mitral PVL. Thirty-five patients (67.3%) underwent multiple cardiac surgeries more than once. PVL was treated with leak site repair in 22 patients (group I) and re-replacement of the mitral valve in 30 patients (group II). Concomitant operations were performed in 34 patients (65.4%). The mean duration of follow up was 57.4 +/- 39.4 months.

There were six (11.5%) in-hospital deaths. Postoperative complications occurred in 19 patients, including low cardiac output syndrome (n = 7). There were no differences in early results between the two groups. The presence of more than moderate tricuspid regurgitation was the only risk factor for in-hospital mortality to reach statistical significance (p = 0.023). During the follow up period, late death occurred in 11 patients, including four cardiac deaths. The 10-year overall survival rate was 57.8%, without intergroup difference (p = 0.699). PVL recurred in 10 patients; the mean rate of freedom from recurrence of PVL was 67.7% at 10 years, and the five- and 10-year major valve-related event-free survival rates were 55.5% and 31.8%, respectively. There were no differences in freedom from recurrence of PVL (p = 0.346) and valve-related event-free survival (p = 0.824) between the two groups.

The surgical treatment of mitral PVL proved to be acceptable when considering the high-risk profile of the patients. However, because of the similar outcomes after leak site repair and re-replacement, a more effective method might be selected on an individual basis when considering the surgical correction of mitral PVL.