Matteo Matteucci1, Sandro Ferrarese2, Cristiano Cantore2, Giulio Massimi2, Sara Facetti3, Vittorio Mantovani2, Giangiuseppe Cappabianca2, Dario Fina4, Roberto Lorusso5, Cesare Beghi2. 1. Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: matteomatteucci87@gmail.com. 2. Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy. 3. Department of Cardiology, Circolo Hospital, University of Insubria, Varese, Italy. 4. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 5. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
Abstract
BACKGROUND: Paravalvular leak (PVL) is a well-known complication after aortic valve replacement (AVR). Although some studies have described the incidence of postoperative aortic PVL, there are conflicting data about the predictive factors and a paucity of evidence regarding their time course and impact on survival. METHODS: Data were collected from patients who underwent surgical AVR at Circolo Hospital in Varese, Italy from January 2014 to December 2017. A transthoracic echocardiogram (TTE) was performed in all patients before hospital discharge. Additionally, a second TTE was obtained during postoperative follow-up in subjects with early aortic PVL. RESULTS: A total of 514 patients were enrolled in the study. At hospital discharge, aortic PVL was present in 60 patients (11.7%); the majority (78.3%) of the PVLs were mild. Multivariate logistic regression analysis identified smaller body surface area, female sex, and operating surgeon as the strongest predictors of early aortic PVL. Follow-up TTE was available for 50 patients (83.3%). Median time from the date of surgery to follow-up TTE was 2.2 years (0.4 to 4 years). Most aortic PVLs remained unchanged (50%) or disappeared (36%) over time. Only 2 patients (4%) had a progression of the leak. Overall, mortality was 8.4% (43 of 514). Survival was negatively affected by the presence of residual, mild to moderate, or moderate aortic PVL. CONCLUSIONS: Aortic PVL is not uncommon after standard AVR. Operating surgeon, smaller body surface area, and female sex are risk factors for the development of this complication. These leaks are usually mild and generally have a benign course. However, the presence of mild to moderate or more severe aortic PVL may influence postoperative survival.
BACKGROUND:Paravalvular leak (PVL) is a well-known complication after aortic valve replacement (AVR). Although some studies have described the incidence of postoperative aortic PVL, there are conflicting data about the predictive factors and a paucity of evidence regarding their time course and impact on survival. METHODS: Data were collected from patients who underwent surgical AVR at Circolo Hospital in Varese, Italy from January 2014 to December 2017. A transthoracic echocardiogram (TTE) was performed in all patients before hospital discharge. Additionally, a second TTE was obtained during postoperative follow-up in subjects with early aortic PVL. RESULTS: A total of 514 patients were enrolled in the study. At hospital discharge, aortic PVL was present in 60 patients (11.7%); the majority (78.3%) of the PVLs were mild. Multivariate logistic regression analysis identified smaller body surface area, female sex, and operating surgeon as the strongest predictors of early aortic PVL. Follow-up TTE was available for 50 patients (83.3%). Median time from the date of surgery to follow-up TTE was 2.2 years (0.4 to 4 years). Most aortic PVLs remained unchanged (50%) or disappeared (36%) over time. Only 2 patients (4%) had a progression of the leak. Overall, mortality was 8.4% (43 of 514). Survival was negatively affected by the presence of residual, mild to moderate, or moderate aortic PVL. CONCLUSIONS: Aortic PVL is not uncommon after standard AVR. Operating surgeon, smaller body surface area, and female sex are risk factors for the development of this complication. These leaks are usually mild and generally have a benign course. However, the presence of mild to moderate or more severe aortic PVL may influence postoperative survival.