Ismail Bouhout1, Amine Mazine1, Aly Ghoneim1, Xavi Millàn2, Ismail El-Hamamsy1, Michel Pellerin1, Raymond Cartier1, Phillipe Demers1, Yoan Lamarche1, Denis Bouchard3. 1. Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada. 2. Department of Interventional Cardiology, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada. 3. Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
Abstract
OBJECTIVES: The aim of this study was to determine immediate results and long-term outcomes after surgical management of paravalvular leak (PVL). METHODS: Between 1995 and 2012, a total of 190 patients underwent primary surgical repair (n = 142) or valve replacement (n = 48) for a PVL at our institution. The PVL was mild in 6 (3%) patients, moderate in 85 (45%), moderate to severe in 84 (44%), and severe in 15 (8%). Among these, 120 (63%) had PVL in the mitral position, 63 (33%) had PVL in the aortic position, and 7 (4%) had PVL in both valves. Mean follow-up was 5.3 ± 4.6 years. RESULTS: Mean age at surgery was 63 ± 12 years (64% men). Operative mortality occurred in 13 (7%) patients (10 [8%] in mitral; 2 [3%] in aortic; and 1 [14%] in double valve procedures). Survival at 1, 5, and 10 years was 85% ± 3%, 73% ± 4%, and 56% ± 5%, respectively. The cumulative incidence of PVL recurrence was 3% ± 1%, 14% ± 3%, and 32% ± 6%, at 1, 5, and 10 years, respectively. The number of previous surgeries was a predictor of survival and PVL recurrence. Freedom from New York Heart Association class ≥III was 96% ± 2%, 82% ± 4%, and 58% ± 6%, at 1, 5, and 10 years, respectively. The freedom from rehospitalization for heart failure was 92% ± 2%, 83% ± 4%, and 67% ± 6%, at 1, 5, and 10 years. CONCLUSIONS: Surgical treatment of PVL resulted in acceptable outcomes. Nevertheless, the continued risk of PVL recurrence is higher in patients who have had multiple previous surgeries. More studies are needed to compare these results with the transcatheter PVL reduction technique.
OBJECTIVES: The aim of this study was to determine immediate results and long-term outcomes after surgical management of paravalvular leak (PVL). METHODS: Between 1995 and 2012, a total of 190 patients underwent primary surgical repair (n = 142) or valve replacement (n = 48) for a PVL at our institution. The PVL was mild in 6 (3%) patients, moderate in 85 (45%), moderate to severe in 84 (44%), and severe in 15 (8%). Among these, 120 (63%) had PVL in the mitral position, 63 (33%) had PVL in the aortic position, and 7 (4%) had PVL in both valves. Mean follow-up was 5.3 ± 4.6 years. RESULTS: Mean age at surgery was 63 ± 12 years (64% men). Operative mortality occurred in 13 (7%) patients (10 [8%] in mitral; 2 [3%] in aortic; and 1 [14%] in double valve procedures). Survival at 1, 5, and 10 years was 85% ± 3%, 73% ± 4%, and 56% ± 5%, respectively. The cumulative incidence of PVL recurrence was 3% ± 1%, 14% ± 3%, and 32% ± 6%, at 1, 5, and 10 years, respectively. The number of previous surgeries was a predictor of survival and PVL recurrence. Freedom from New York Heart Association class ≥III was 96% ± 2%, 82% ± 4%, and 58% ± 6%, at 1, 5, and 10 years, respectively. The freedom from rehospitalization for heart failure was 92% ± 2%, 83% ± 4%, and 67% ± 6%, at 1, 5, and 10 years. CONCLUSIONS: Surgical treatment of PVL resulted in acceptable outcomes. Nevertheless, the continued risk of PVL recurrence is higher in patients who have had multiple previous surgeries. More studies are needed to compare these results with the transcatheter PVL reduction technique.
Authors: Ignacio Cruz-González; Pablo Luengo-Mondéjar; Blanca Trejo-Velasco; Jean C Núñez-García; Rocío González-Ferreiro; José C Moreno-Samos; Mónica Fuertes-Barahona; Juan C Rama-Merchán; Pablo Antúnez-Muiños; Sergio López-Tejero; Gilles Barreira de Sousa; Javier Rodríguez-Collado; Javier Martín-Moreiras; Alejandro Diego-Nieto; Jesús Herrero-Garibi; Manuel Barreiro-Pérez; Elena Díaz-Peláez; Pedro L Sánchez Fernández Journal: J Clin Med Date: 2022-08-18 Impact factor: 4.964
Authors: Igor Vyacheslavovich Buzaev; Gulchachak Khalikova; Vladimir Vyacheslavovich Plechev; Eustaquio Maria Onorato Journal: Eur Heart J Case Rep Date: 2021-06-05