Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery?

Genoni, Michele; Franzen, Daniel; Vogt, Paul; Seifert, Burkhardt; Jenni, Rolf; Künzli, Andreas; Niederhäuser, U; Turina, Marko

doi:10.1016/s1010-7940(99)00358-9

Cited by 194 publications

(163 citation statements)

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“…The median EuroSCORE II of our cohort (9.5%) falls within the range (7.5% to 9.6%) described by other contemporary series (3,4). Residual mitral PVL has been reported in 2% to 22% of patients following surgical correction (1,3,4). Recurrence of PVL has been cited to occur at a rate of 4% per patient-year (3).…”

Section: Discussionmentioning

confidence: 99%

“…Hwang and associates (2) reported that 74% of PVLs occur during the first postoperative year. It is extremely rare for PVLs to occur more than 20 years after MVR (1,3,5). The longest interval between the latest MVR and diagnosis of a new PVL in our series was 29 years, which exceeds the longest interval (27 years) reported to date (3).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of paravalvular leak (PVL), defined as a regurgitant jet between the prosthetic sewing ring and native tissues on transoesophageal echocardiography (TEE), occurs in 5-32% of patients following mitral valve replacement (MVR) (1,2). Most cases of PVL remain clinically silent, but patients presenting with persistent symptoms of congestive cardiac failure, haemolytic anaemia, or a combination of both may benefit from surgical repair.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of PVLs occur during the first postoperative year (2). It is extremely rare for patients to develop PVL decades after MVR (1). Previous reports have cited the longest period between MVR and the diagnosis of a new PVL to be 27 years (3).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Most mitral paravalvular leaks (PVLs) occur during the first year after mitral valve replacement (MVR). This report describes the surgical management of 6 patients who developed very late mitral PVLs.The median interval between MVR and initial diagnosis of PVL was 16.5 years. All patients presented with congestive cardiac failure and haemolytic anaemia. The median EuroSCORE II was 9.5%. Two patients (33%) had failed attempts at transcatheter closure. Five patients underwent suture repair of the PVL. One patient underwent MVR after removal of the previous prosthesis. No in-hospital mortalities occurred. At latest follow-up (median 3.3 years), 5 patients (83%) were asymptomatic with no residual PVL. Haemolytic anaemia persisted in 1 patient with a mild residual PVL. PVL occurring decades after MVR is a rare but serious complication. Reoperative surgery can be performed in these high-risk patients with satisfactory early and midterm outcomes. J Thorac Dis 2016;8(9):E952-E956 jtd.amegroups.com images were available for 5 patients (Figure 1). The median EuroSCORE II was 9.5% (range: 4.0% to 42.2%). The median left ventricular ejection fraction (LVEF) was 61% (range: 55% to 67%).Two patients had undergone unsuccessful percutaneous closure of PVL, which failed due to either significant residual regurgitation or the closure device interfering with the existing mitral prosthesis. One patient who received 2 occluder devices required emergency surgery due to cardiogenic shock, resulting from a closure device being caught between the leaflets of the mitral prosthesis. Five patients with discrete PVLs in the presence of a calcified mitral annulus underwent direct suture repair without removal of the existing mitral prosthesis. One patient with multiple PVLs at various sites along the sewing ring underwent MVR after extirpation of the previous prosthetic valve. Concomitant procedures were performed in 4 patients ( Table 1). The median aortic cross-clamp and cardiopulmonary bypass times were 50 minutes (range, 42 to 119 minutes) and 99 minutes (range, 72 to 196 minutes), respectively.There were no in-hospital mortalities. Postoperative complications are listed in Table 1. No patients suffered from postoperative stroke, myocardial infarction or required insertion of a permanent pacemaker. Upon discharge from hospital, five patients (83.3%) had no residual PVL and 1 patient (16.7%) had mild residual PVL.All patients were reviewed at our institution during scheduled clinic consultations. The median follow up period was 3.3 years (range: 1.9 to 4.8 years). There were no late mortalities. Five patients (83.3%) were in NYHA class I and had no recurrence of haemolytic anaemia. Four patients (66.7%) had no recurrence of PVL and two patients (33.3%) had mild PVL during follow-up echocardiographic assessment ( Table 1). In the patient who underwent salvage surgery following failed transcatheter repair, haemolysis persisted despite surgical correction, due to a turbulent jet flowing through a mild residual PVL. The patient op...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Operative mortality is 6% to 14% (21,22). Besides, PVL can occur approximately in up to 10% of cases of prosthetic valve reoperation (23,24). In most reoperation cases, exposure of the mitral valve is difficult due to severe adhesions.…”

Section: Discussionmentioning

confidence: 99%

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

Gürsoy

Astarcıoğlu²,

Gökdeniz³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Paravalvular leaks (PVLs) commonly occur in mitral prostheses. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) may provide invaluable information about complex 3D anatomy of mitral PVLs compared to two-dimensional (2D) TEE findings. We, herein, aimed to evaluate the detailed description of anatomical characteristics of severe mitral PVLs using RT-3D TEE. Methods: Patients with diagnosis of severe mitral PVLs were simultaneously examined with 2D transthoracic echocardiography (TTE), 2D TEE, and RT-3D TEE. 3D characteristics of PVLs (localization, number, size, shape, etc.) were recorded and compared to 2D findings. Results were also compared with surgical findings. Results: The study comprised 47 cases (3 bioprosthesis, 44 mechanical) with 61 severe mitral PVLs. The most common PVL localizations were anterolateral commissure, posteromedial commissures and posterolateral region. The mean PVL width measured by 2D TEE was 3.1±1.3 (range; 2-7) mm and the mean width of defect measured by 3D TEE was 3.1±1.1 (range; 2-7) mm (p=0.7). The mean length of defect measured by 3D TEE was 11.1±6.5 mm. The most common defect type was 'oval/round' shaped (n=29; 48%). There were also 19 'crescentic' (31%), 9 'slit like' (15%), and 2 tunnel-like shaped defects. In 22 patients, the site and dimension of the PVLs were all confirmed surgically. Conclusion: RT-3D TEE permits detailed structural evaluation of the prosthesis and description of paravalvular leak morphology compared to 2D TEE. It may provide more accurate information to the clinician in decision making and may contribute to the success of the potential corrective procedures. (Anadolu Kardiyol Derg 2013; 13: 633-40) Key words: Paravalvular mitral regurgitation, real-time three-dimensional transözofageal echocardiography Original Investigation Özgün Araşt›rma 633ÖZET Amaç: Paravalvüler kaçaklar (PVK) genellikle mitral protez kapaklarda görülür. Gerçek zamanlı üç-boyutlu transözofageal ekokardiyografi (GZ-3B TÖE) iki boyutlu transözofageal ekokardiyografi (2B TÖE) ile kıyaslandığında mitral protez kapağın kompleks 3B anatomisi hakkında paha biçilmez bilgiler sunar. Bu çalışmada GZ-3B TÖE'yi kullanarak ileri mitral PVK'ların detaylı anatomik özelliklerini incelemeyi hedefledik.Yöntemler: İleri PVK'sı olan hastalar eş zamanlı 2B transtorasik ekokardiyografi, 2B TÖE ve GZ-3B TÖE ile incelendi. PVK'ların 3B özellikleri (yerleşimi, boyutları, şekilleri, sayıları vs.) kaydedildi ve 2B görüntülerle kıyaslandı. Sonuçlar cerrahi bulgularla da kıyaslandı. Bulgular: Çalışma 47 mitral protez kapak hastasını (3 biyoprotez, 44 mekanik) ve toplam 61 PVK'yı kapsıyordu. En sık PVK yerleşimi anterolateral komissür, posteromediyal komissür ve posterolateral bölge idi. 2B TÖE ve 3B ile ölçülen ortalama defekt eni sırasıyla 3,1±1,3 (aralık; 2-7) mm ve 3,1±1,1 (aralık; 2-7) mm idi (p=0,7). 3B TÖE ile ölçülen defekt uzunluğu ise 11,1±6,5 mm idi. En sık defekt türü 'oval/yuvarlak' (n=29; %48) idi. Ayrıca 19 hilal şekilli (%31), 9 kesik şekilli (%15) ve 2 tünel...

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Paravalvular Leak Closure and Ventricular Septal Defect Closure

Sanon

Eleid

Cabalka

et al. 2016

Interventional Cardiology

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Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery?

Abstract: Following mitral valve replacement, a more aggressive surgical treatment is recommended for patients with paraprosthetic leaks. Surgery should be offered to less symptomatic patients, as well as those not requiring blood transfusion.

Cited by 194 publications

References 11 publications

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

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

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

Paravalvular Leak Closure and Ventricular Septal Defect Closure

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