Reoperation for mitral paravalvular leak: a single-centre experience with 200 patients

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Prosthetic Valve Complications

Background:

• Paravalvular leak (PVL) is a serious complication following mitral valve replacement, leading to significant morbidity and mortality.
• Limited data exists on risk factors and long-term surgical outcomes for patients experiencing PVL.

Purpose of the Study:

• To investigate the risk factors associated with paravalvular leak (PVL) after mitral valve replacement.
• To analyze the long-term surgical outcomes and survival rates in patients undergoing reoperation for mitral PVL.

Main Methods:

• A retrospective analysis of 206 patients who underwent reoperation for mitral PVL between 1995 and 2012.
• Evaluation of patient demographics, comorbidities, surgical procedures, early outcomes, and long-term survival.
• Multivariate analysis to identify predictors of late mortality and PVL recurrence.

Main Results:

• The most common site for PVL was the aortomitral curtain (40%). Early mortality was 5%, with overall survival at 1, 5, and 15 years at 83%, 62%, and 16%, respectively.
• Predictors of late mortality included advanced NYHA class, active endocarditis, chronic steroid use, prior CABG, elevated creatinine, need for dialysis, and residual PVL.
• Active endocarditis and chronic steroid use were significant predictors of PVL recurrence, which occurred in 21% of patients.

Conclusions:

• Paravalvular leak (PVL) significantly contributes to morbidity and mortality post-mitral valve replacement.
• While re-repair is feasible, recurrent PVL is a risk factor for late mortality.
• Reoperation for PVL should be considered before the development of advanced heart failure to improve patient outcomes.