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Factors associated with periprosthetic leakage following primary mitral valve replacement: with special consideration
Abstract:
Among 435 patients without native valve endocarditis who were followed up to 69 months after primary mitral valve replacement, 25 developed documented periprosthetic leakage. In 10 patients this was associated with prosthetic valve infection. No evidence of prosthetic infection was found in the remaining 15 patients with documented leakages, and they form the basis of the study. Multivariate Cox regression analysis indicated that leakage in the absence of infection was strongly associated with the use of small monofilament suture (2-0 or 3-0 versus 1-0) in a continuous suture technique (92.0% actuarially leak free by 43 months versus 99.0% for continuous 1-0 monofilament sutures or pledgeted mattress sutures; p = 0.01) and with annular calcification (p = 0.01). We did not find (p greater than 0.2) the functional type of mitral valve lesion or its pathology, or the type and size of prosthesis used, to be incremental risk factors.
Insights
Small monofilament sutures and annular calcification increase the risk of mitral valve leakage after replacement surgery. These factors are associated with periprosthetic leakage in the absence of infection, impacting long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Periprosthetic leakage is a known complication following mitral valve replacement.
- Differentiating leakage with and without prosthetic valve infection is crucial for management.
- Understanding risk factors for non-infectious leakage can improve surgical outcomes.
Purpose of the Study:
- To identify risk factors for periprosthetic mitral valve leakage in the absence of prosthetic valve infection.
- To evaluate the association between suture material, technique, and annular calcification with leakage.
- To determine if valve type or lesion pathology influences leakage risk.
Main Methods:
- Retrospective analysis of 435 patients undergoing primary mitral valve replacement without native valve endocarditis.
- Multivariate Cox regression analysis to assess risk factors for periprosthetic leakage.
- Categorization of leakage based on prosthetic valve infection status.
Main Results:
- Leakage without infection occurred in 15 patients.
- Small monofilament sutures (2-0 or 3-0) in a continuous technique were significantly associated with leakage (p=0.01).
- Annular calcification was also a significant risk factor for leakage (p=0.01).
Conclusions:
- The choice of suture material and technique, along with the presence of annular calcification, are critical factors influencing non-infectious periprosthetic mitral valve leakage.
- These findings suggest specific surgical considerations to minimize leakage risk.
- Mitral valve lesion type, pathology, and prosthesis characteristics were not significant risk factors.