Surgical treatment of paravalvular leak: Long-term results in a single-center experience (up to 14 years)

Taramasso, Maurizio; Maisano, Francesco; Denti, Paolo; Guidotti, Andrea; Sticchi, Alessandro; Pozzoli, Alberto; Buzzatti, Nicola; Bonis, Michele De; Canna, Giovanni La; Alfieri, Ottavio

doi:10.1016/j.jtcvs.2014.12.041

Cited by 99 publications

(97 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Operative mortality ranges from 6% to 13 % (1-4). 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).…”

Section: Discussionsupporting

confidence: 78%

“…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%

“…Surgery is indicated for patients experiencing progressive and recurrent heart failure symptoms refractory to optimal medical therapy and/or persistent haemolysis requiring increasingly frequent blood transfusions (3,4). Compared to conservative management, surgical repair has been shown to relieve symptoms, decrease the need for blood transfusion and improve survival (1).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2016

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Recent TAVR and surgical PVR studies report that mild PVR after surgical AVR is not uncommon, with reported PVR rates between 1% and 47%. 9,[18][19][20] In the most frequently cited studies, conventional surgical AVR has a reported PVR incidence between 2% and 17%. 6,7,12,21 In comparison, the overall incidence of PVR 1þ or greater after AVR in the current study was 2.2%.…”

Section: Previous Studies Of Surgical Paravalvular Regurgitationmentioning

confidence: 99%

“…Advances in surgical valve technology, refinement of surgical technique, and experience have most likely contributed to contemporary PVR rates at or below the lower end of the historical reported incidence, even with ever-improving echocardiographic technology. In a recent study, Taramasso and colleagues 19 reported that the surgical treatment of PVR is still high and that long-term outcomes remain suboptimal. Future comparisons with TAVR data and emerging technologies such as sutureless AVR and percutaneous MVR should consider the significantly lower contemporary rate of PVR after surgical AVR and MVR.…”

Section: Previous Studies Of Surgical Paravalvular Regurgitationmentioning

confidence: 99%