Reoperation for mitral paravalvular leak

A single-centre experience with 200 patients†

Sameh M. Said, Hartzell V Schaff, Kevin L. Greason, Alberto Pochettino, Richard C. Daly, Joseph A. Dearani

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)806-812
Number of pages7
JournalInteractive Cardiovascular and Thoracic Surgery
Volume25
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Reoperation
Endocarditis
Mortality
Steroids
Mitral Valve
Recurrence
Creatinine
Heart Failure
Morbidity
Cardiogenic Shock
Hemolytic Anemia
Coronary Artery Bypass
Dialysis
Multivariate Analysis

Keywords

  • Device closure
  • Mitral valve reoperation
  • Paravalvular leak

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Reoperation for mitral paravalvular leak : A single-centre experience with 200 patients†. / Said, Sameh M.; Schaff, Hartzell V; Greason, Kevin L.; Pochettino, Alberto; Daly, Richard C.; Dearani, Joseph A.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 25, No. 5, 01.11.2017, p. 806-812.

Research output: Contribution to journalArticle

Said, Sameh M. ; Schaff, Hartzell V ; Greason, Kevin L. ; Pochettino, Alberto ; Daly, Richard C. ; Dearani, Joseph A. / Reoperation for mitral paravalvular leak : A single-centre experience with 200 patients†. In: Interactive Cardiovascular and Thoracic Surgery. 2017 ; Vol. 25, No. 5. pp. 806-812.
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title = "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.",
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T1 - Reoperation for mitral paravalvular leak

T2 - A single-centre experience with 200 patients†

AU - Said, Sameh M.

AU - Schaff, Hartzell V

AU - Greason, Kevin L.

AU - Pochettino, Alberto

AU - Daly, Richard C.

AU - Dearani, Joseph A.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

KW - Device closure

KW - Mitral valve reoperation

KW - Paravalvular leak

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