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

Genoni, Michele ; Franzen, Daniel ; Vogt, Paul ; Seifert, Burkhardt ; Jenni, Rolf ; Künzli, Andreas ; Niederhäuser, Urs ; Turina, Marko

In: European Journal of Cardio-Thoracic Surgery, 2000, vol. 17, no. 1, p. 14-19

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    Titre
    • Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery?
    Auteur
    • Genoni, Michele. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Franzen, Daniel. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Vogt, Paul. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Seifert, Burkhardt. Department of Biostatistics ISPM, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Jenni, Rolf. Division of Echocardiography, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Künzli, Andreas. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Niederhäuser, Urs. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Turina, Marko. Division of Cardiac Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2000, vol. 17, no. 1, p. 14-19. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:298684
    Summary
    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