Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

被引:52
作者
Hwang, Ho Young
Choi, Jae-Woong
Kim, Hyung-Kwan
Kim, Kyung-Hwan
Kim, Ki-Bong
Ahn, Hyuk [1 ]
机构
[1] Seoul Natl Univ Hosp, Dept Thorac & Cardiovasc Surg, Seoul 110744, South Korea
关键词
TRANSESOPHAGEAL ECHOCARDIOGRAPHY; SUTURE TECHNIQUE; REGURGITATION; SURVIVAL;
D O I
10.1016/j.athoracsur.2015.03.104
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We evaluated the incidence of paravalvular leak (PVL) after mitral valve replacement (MVR) and analyzed factors associated with early and late PVL during more than 20 years of follow-up. Methods. We studied 1,202 patients (50.4 +/- 12.2 years; male/female, 456: 746) who underwent MVR between 1992 and 2008. Follow-up duration was 134 months (range, 1 to 272 months). Incidence of early and late PVL was evaluated. The PVL was regarded as major if it caused hemolysis requiring multiple transfusions or regurgitant jet inducing heart failure symptoms. Results. In-hospital mortality rate was 4.5%. Early mitral PVL was found in 23 patients (1.9%), including 7 patients with major PVL. Late mitral PVL without obvious infection occurred in 75 patients (major PVL in 55 patients). Median interval between the index operation and major PVL was 136 months (range, 6 to 250 months). Among 55 patients with major PVL, 50 patients underwent reoperations and 5 patients were treated medically. Ten-and 20-year late mitral PVL-free rates were 96.2% and 86.9%, respectively. Ten-and 20-year major mitral PVL-free rates were 98.0% and 89.3%, respectively. Cox proportional hazard analysis revealed that age (hazard ratio, 1.052; 95% confidence interval, 1.024 to 1.079), male sex (hazard ratio, 2.804; 95% confidence interval, 1.629 to 4.828), and redo MVR (hazard ratio, 5.193; 95% confidence interval, 2.930 to 9.112) were associated with major mitral PVL during the follow-up. Conclusions. Major PVL without obvious infection occurs even 20 years after MVR with 10- and 20-year major PVL-free rates of 96.2% and 86.9%, respectively. Occurrence of major PVL after MVR is more frequent in elderly, male patients and those who undergo redo MVR. (C) 2015 by The Society of Thoracic Surgeons
引用
收藏
页码:1347 / 1352
页数:6
相关论文
共 13 条
  • [1] Choi JW, 2013, J HEART VALVE DIS, V22, P682
  • [2] FACTORS ASSOCIATED WITH PERIPROSTHETIC LEAKAGE FOLLOWING PRIMARY MITRAL-VALVE REPLACEMENT - WITH SPECIAL CONSIDERATION OF THE SUTURE TECHNIQUE
    DHASMANA, JP
    BLACKSTONE, EH
    KIRKLIN, JW
    KOUCHOUKOS, NT
    [J]. ANNALS OF THORACIC SURGERY, 1983, 35 (02) : 170 - 178
  • [3] Importance of implant technique on risk of major paravatvutar teak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT)
    Englberger, L
    Schaff, HV
    Jamieson, WRE
    Kennard, ED
    Im, KA
    Holubkov, R
    Carrel, TP
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005, 28 (06) : 838 - 843
  • [4] PATTERNS OF NORMAL TRANSVALVULAR REGURGITATION IN MECHANICAL VALVE PROSTHESES
    FLACHSKAMPF, FA
    OSHEA, JP
    GRIFFIN, BP
    GUERRERO, L
    WEYMAN, AE
    THOMAS, JD
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1991, 18 (06) : 1493 - 1498
  • [5] Paravalvular leakage after mitral valve replacement:: improved long-term survival with aggressive surgery?
    Genoni, M
    Franzen, D
    Vogt, P
    Seifert, B
    Jenni, R
    Künzli, A
    Niederhäuser, U
    Turina, M
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2000, 17 (01) : 14 - 19
  • [6] Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up
    Hwang, Ho Young
    Choi, Jae-Woong
    Kim, Hyung-Kwan
    Kim, Kyung-Hwan
    Kim, Ki-Bong
    Ahn, Hyuk
    [J]. ANNALS OF THORACIC SURGERY, 2015, 100 (04) : 1347 - 1352
  • [7] Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography
    Ionescu, A
    Fraser, AG
    Butchart, EG
    [J]. HEART, 2003, 89 (11) : 1316 - 1321
  • [8] When and how does nonstructural mechanical prosthetic heart valve dysfunction occur?
    Yoshio Misawa
    Tsutomu Saito
    Hiroaki Konishi
    Shin-ichi Oki
    Yuichiro Kaminishi
    Hideki Takahashi
    Kei Aizawa
    Osamu Kamisawa
    Morito Kato
    Katsuo Fuse
    [J]. The Japanese Journal of Thoracic and Cardiovascular Surgery, 2003, 51 (8) : 355 - 360
  • [9] Movsowitz H D, 1994, J Am Soc Echocardiogr, V7, P488
  • [10] Effect of Valve Suture Technique on Incidence of Paraprosthetic Regurgitation and 10-Year Survival
    Nair, Sukumaran K.
    Bhatnagar, Gauraang
    Valencia, Oswaldo
    Chandrasekaran, Venkatachalam
    [J]. ANNALS OF THORACIC SURGERY, 2010, 89 (04) : 1171 - 1179