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Eur J Cardiothorac Surg 2006;30:887-891
© 2006 Elsevier Science NL

Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study

^a Cardiac Surgery Unit, Civic Hospital, Brescia, Italy
^b Department of Cardiovascular Surgery, De Gasperis Centre, Niguarda Ca’ Granda Hospital, Milan, Italy
^c Department of Cardiac Surgery, University of Parma, Parma, Italy
^d Department of Cardiac Surgery, Humanitas Gavazzeni Clinic, Bergamo, Italy

Received 19 May 2006; received in revised form 8 September 2006; accepted 18 September 2006.

^_* Corresponding author. Address: U.O. di Cardiochirurgia, Spedali Civili di Brescia, Piazzale Spedali Civili, 1-25125 Brescia, Italy. Tel.: +39 030 3995636; fax: +39 030 3995004. (Email: giudeci{at}libero.it).

Objective: Prosthetic valve dysfunction after mitral valve replacement (MVR) may be caused by several factors, which often lead to repeated surgery. One of the most frequent determinants of reoperation is periprosthetic leakage (PPL). A few published reports have analysed PPL incidence and postoperative results after MVR, but no specific attention has been paid towards the potential relation between anatomical factors and PPL occurrence, particularly not bacterial-related. The aim of this study was to evaluate the location of PPL after MVR through a multicentre retrospective study. Methods: Between January 1985 and November 2005, 135 patients underwent reoperation at four institutions because of PPL after MVR and met the study inclusion criteria. The mitral valve annulus (MVA) was analysed in a clockwise format, indicating 12 o’clock as the mid-point of anterior annulus as viewed from the atrium. Results: Overall hospital mortality was 3.7% (five patients). Repair of PPL was carried out in 83 cases whereas prosthetic valve replacement was necessary in 52 cases. The total number of sectors involved in PPL was 244. PPL occurred more frequently between hour 5 and hour 6, and hour 10 and hour 11, with the risk of leakage being, 2.8 and 2.0 times higher, respectively, than in any other portion of the MVA. Conclusions: Our study suggests that PPL occurs more frequently at antero-lateral and postero-medial segments of MVA. This finding might be linked to unusual anatomical and functional factors of the MVA and may call for adjunctive care to these sectors of MVA when performing suture placement during MVR.

Key Words: Mitral periprosthetic leakage • Mitral annulus • Prosthetic valve

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