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Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period

[ Vol. 14 , Issue. 1 ]

Author(s):

Melvin Dziubek, Charalampos Pierrakos, Louis Chebli, Helene Demanet, Ahmed Sanoussi and Pierre Wauthy*   Pages 15 - 24 ( 10 )

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.

Keywords:

Mitral valve paravalvular leakage, mitral annulus, prosthetic valve, mitral valve replacement, early mitral paraprosthetic leak, late mitral para-prosthetic leak, morbidity.

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

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