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Kananathan S, Perera LA, Mohanarajan M, Sherif M, Harky A. The management of paravalvular leaks post aortic valve replacement. J Card Surg 2022; 37:2786-2798. [PMID: 35695718 DOI: 10.1111/jocs.16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions. AIM To discuss the classification of PVLs, diagnostic approaches, and available management options. METHOD A literature review was performed using 28 studies. RESULTS This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes. DISCUSSION Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. CONCLUSION Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.
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Affiliation(s)
- Shalini Kananathan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | | | - Maneeshaa Mohanarajan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Matteucci M, Ferrarese S, Cantore C, Mantovani V, Pedroni G, Cappabianca G, Corazzari C, Kowalewski M, Severgnini P, Lorusso R, Beghi C. Early paravalvular leak after conventional mitral valve replacement: A single-center analysis. J Card Surg 2022; 37:1559-1566. [PMID: 35289962 PMCID: PMC9314703 DOI: 10.1111/jocs.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/02/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
Introduction Paravalvular leak (PVL) is a well‐recognized complication after mitral valve replacement (MVR). However, there are only a few studies analyzing leak occurrence and postoperative results after surgical MVR. The aim of this study was to assess the rate and determinants of early mitral PVL and to evaluate the impact on survival. Methods We performed a retrospective analysis involving patients who underwent MVR from January 2012 to December 2019 at our Institution. Postoperative transthoracic echocardiography evaluation was done for all subjects before hospital discharge. Multivariable analysis was carried out by constructing a logistic regression model to identify predictors for PVL occurrence. Results Four hundred ninety‐four patients were enrolled. Operative mortality was 4.9%. Early mitral PVL was found in 16 patients (3.2%); the majority were mild (75%). Leaks occurred more frequently along the posterior segment of the mitral valve annulus (62.5%). Only one individual with moderate‐to‐severe PVL underwent reoperation during the same hospital admission. Multivariable analysis revealed that preoperative diagnosis of infective endocarditis was the only factor associated with early leak after MVR (odds ratio: 4.96; 95% confidence interval: 1.45–16.99; p = .011). Overall mortality at follow‐up (mean follow‐up time: 4.7 [SD: 2.5] years) was 19.6% and favored patients without early mitral PVL. Conclusion The incidence of early PVL after MVR is low. PVL is usually mild and develop more frequently along the posterior segment of the mitral valve annulus. Preoperative diagnosis of infective endocarditis increases the risk of PVL formation.
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Affiliation(s)
- Matteo Matteucci
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cristiano Cantore
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giada Pedroni
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland.,Thoracic Research Centre, Collegium Medicum, Innovative Medical Forum, Nicolaus Copernicus University, Bydgoszcsz, Poland
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
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Early Aortic Paravalvular Leak After Conventional Cardiac Valve Surgery: A Single-Center Experience. Ann Thorac Surg 2020; 109:517-525. [DOI: 10.1016/j.athoracsur.2019.05.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 11/18/2022]
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