Title:Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period
VOLUME: 14 ISSUE: 1
Author(s):Melvin Dziubek, Charalampos Pierrakos, Louis Chebli, Helene Demanet, Ahmed Sanoussi and Pierre Wauthy*
Affiliation:Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Department of Intensive Care, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles
Keywords:Mitral valve paravalvular leakage, mitral annulus, prosthetic valve, mitral valve replacement, early mitral paraprosthetic
leak, late mitral para-prosthetic leak, morbidity.
Abstract:Background: Mitral para-prosthetic leaks are rare but major complications of mitral
heart valve replacements. When they must be re-operated, they are burdened with high mortality
rates. We proposed to review our surgical experience in terms of approach and type of operation
carried out.
Methods: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients
benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University
Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify
the risk factors of postoperative mortality. We then compared the data depending on the approach
and the type of surgical treatment in order to compare the morbidity-mortality.
Results: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in
lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney
failure were significantly more common in the decease population. Direct mitral paravalvular leak
suturing was more frequently performed on early apparition, anterior and isolated leaks, whereas a
mitral heart valve replacement was most often performed to cure active primary endocarditis. The
incidence of complications and mortality rates were identical according to the approach and the
type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the
cases.
Conclusion: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality
rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered
in those patients.
