Early paravalvular leak after conventional mitral valve replacement: A single‐center analysis

• Published in: Journal of cardiac surgery Vol. 37; no. 6; pp. 1559 - 1566
• Main Authors: Matteucci, Matteo, Ferrarese, Sandro, Cantore, Cristiano, Mantovani, Vittorio, Pedroni, Giada, Cappabianca, Giangiuseppe, Corazzari, Claudio, Kowalewski, Mariusz, Severgnini, Paolo, Lorusso, Roberto, Beghi, Cesare
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.06.2022
• Subjects: Endocarditis - surgery; Follow-Up Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; mitral regurgitation; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; mitral valve replacement; Original; paravalvular leak; Retrospective Studies; Time Factors; Treatment Outcome; mitral regurgitation; paravalvular leak; mitral valve replacement
• ISSN: 0886-0440; 1540-8191; 1540-8191
• DOI: 10.1111/jocs.16422

Introduction Paravalvular leak (PVL) is a well‐recognized complication after mitral valve replacement (MVR). However, there are only a few studies analyzing leak occurrence and postoperative results after surgical MVR. The aim of this study was to assess the rate and determinants of early mitral PVL and to evaluate the impact on survival. Methods We performed a retrospective analysis involving patients who underwent MVR from January 2012 to December 2019 at our Institution. Postoperative transthoracic echocardiography evaluation was done for all subjects before hospital discharge. Multivariable analysis was carried out by constructing a logistic regression model to identify predictors for PVL occurrence. Results Four hundred ninety‐four patients were enrolled. Operative mortality was 4.9%. Early mitral PVL was found in 16 patients (3.2%); the majority were mild (75%). Leaks occurred more frequently along the posterior segment of the mitral valve annulus (62.5%). Only one individual with moderate‐to‐severe PVL underwent reoperation during the same hospital admission. Multivariable analysis revealed that preoperative diagnosis of infective endocarditis was the only factor associated with early leak after MVR (odds ratio: 4.96; 95% confidence interval: 1.45–16.99; p = .011). Overall mortality at follow‐up (mean follow‐up time: 4.7 [SD: 2.5] years) was 19.6% and favored patients without early mitral PVL. Conclusion The incidence of early PVL after MVR is low. PVL is usually mild and develop more frequently along the posterior segment of the mitral valve annulus. Preoperative diagnosis of infective endocarditis increases the risk of PVL formation.