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

Philip Y K Pang1, Jiasi Zhu1, Yoong Kong Sin1

  • 1Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.

Journal of Thoracic Disease
|October 18, 2016
PubMed

Insights

Very late mitral paravalvular leaks (PVLs) are rare but serious complications decades after mitral valve replacement (MVR). Reoperative surgery offers satisfactory outcomes for these high-risk patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Heart Valve Repair

Background:

  • Mitral paravalvular leaks (PVLs) typically manifest within the first year post-mitral valve replacement (MVR).
  • Very late PVLs, occurring decades after MVR, represent a rare but significant clinical challenge.

Observation:

  • This study details the surgical management of 6 patients with very late mitral PVLs, diagnosed a median of 16.5 years after MVR.
  • Patients presented with severe symptoms including congestive cardiac failure and haemolytic anaemia, with a median EuroSCORE II of 9.5%.
  • Two patients had prior failed transcatheter closure attempts.

Findings:

  • Five patients underwent successful suture repair of the mitral PVL, and one patient required re-mitral valve replacement.
  • No in-hospital mortality was observed.
  • At a median follow-up of 3.3 years, 83% of patients were asymptomatic with no residual PVL; one patient had persistent haemolytic anaemia due to a mild residual leak.

Implications:

  • Reoperative surgical intervention for very late mitral PVLs is feasible and effective in high-risk patients.
  • Surgical management can lead to favorable early and midterm outcomes, improving patient quality of life.
  • This study highlights the importance of considering late complications after MVR and the role of surgical expertise in managing these challenging cases.
Keywords:
Heart valve prosthesismitral valve replacement (MVR)paravalvular leak (PVL)

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