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

Abstract

OBJECTIVES Paravalvular leak (PVL) is a major cause of morbidity and mortality after mitral valve replacement. Risk factors and data on long-Term surgical outcomes are lacking. METHODS Between January 1995 and December 2012, 206 [118 males (57%)] patients underwent reoperation due to mitral PVL. Mean age was 64 ± 11 years. Haemolytic anaemia was present in 85 (41%) patients, while 137 (67%) patients were in New York Heart Association Class III or IV. Baseline creatinine was above 1.5 in 91 (44%) patients, while chronic steroids were used in 14 (7%) patients. Active endocarditis was present in 8 (4%) patients. Device occlusion was attempted in 21 (10%) patients. RESULTS PVL was most common at the aortomitral curtain (82 patients, 40%). Repair was possible in 105 (51%) patients. Early mortality occurred in 11 (5%) patients. Mean follow-up was 5 (maximum 19) years. Overall survival at 1, 5 and 15 years was 83%, 62% and 16%, respectively. Death due to heart failure or cardiogenic shock occurred in 39 patients. Recurrence occurred in 43 (21%) patients and reoperation was required in 19 patients. Multivariate analysis revealed advanced New York Heart Association class (P < 0.0001), active endocarditis (P = 0.013), chronic steroids (P = 0.022), previous coronary artery bypass grafting (P = 0.026), baseline creatinine above 1.5 (P = 0.001), postoperative need for dialysis (P = 0.036) and residual PVL (P < 0.0001) to be predictors of late mortality. Active endocarditis (P = 0.0004) and chronic steroids (P = 0.002) were significant predictors for PVL recurrence. Freedom from reoperation due to PVL recurrence was 89% and 84%, while freedom from late intervention was 94% and 61% at 5 and 15 years, respectively. CONCLUSIONS PVL after mitral valve replacement is associated with increased morbidity and mortality. Re-repair is possible, but recurrent PVL is a risk factor for late mortality, and reoperation should be performed prior to the onset of advanced heart failure.