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Eur J Cardiothorac Surg 2000;17:14-19
© 2000 Elsevier Science NL

Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery?

^a Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
^b Department of Biostatistics ISPM, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
^c Division of Echocardiography, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland

Corresponding author. Tel.: +41-1-255-2303; fax: +41-1-255-4446
e-mail: michele.genoni{at}triemli.stzh.ch

Background: Following mitral valve replacement, surgical closure of paravalvular leaks is usually advised in severely symptomatic patients and in those requiring blood transfusions for persisting haemolysis. However, the long-term prognosis of less symptomatic patients or those not needing blood transfusions is unknown. Methods: Between 1987 and 1997, we observed 96 patients with mitral paravalvular leakage. A paraprosthetic leak was diagnosed after a median time of 119 days (range: 1 day–23 years) after primary mitral valve replacement. During an average follow-up of 5 years (range: 1–23 years), 50/96 patients were referred for surgical closure. Results: Compared with patients who received conservative treatment, those referred for surgery had a significantly lower mean preoperative haematocrit (P=0.002) with a higher proportion of patients being in the NYHA class III/IV (P=0.03). Age, gender, left ventricular function and number and size of leaks did not differ between the groups. The 30-day postoperative mortality for valve reoperation was 6% (3/50); during follow-up three further patients died, resulting in an overall mortality rate of 12%. In the group treated conservatively there was a mortality rate of 26% (12/46). Thus, the actuarial survival for patients referred for surgery was 98, 90 and 88% after 1, 5 and 10 years, compared with 90, 75 and 68% for patients treated conservatively (long-rank P=0.03). In addition, there was a significant increase in mean haematocrit levels (P=0.0001) and an improvement in NYHA class III/IV symptoms (P=0.002), vertigo (P=0.001) and fatigue (P=0.001) after surgery. Conclusions: Following mitral valve replacement, a more aggressive surgical treatment is recommended for patients with paraprosthetic leaks. Surgery should be offered to less symptomatic patients, as well as those not requiring blood transfusion.

Key Words: Surgery • Mitral valve replacement • Paravalvular leaks • Survival

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