For a study, Paravalvular leak (PVL) was a common complication following aortic valve (AV) and mitral valve (MV) surgery, and it can be caused by infection or valve dehiscence. Researchers wanted to see if any factors could predict long-term outcomes in patients who acquired PVL following AV and MV surgery and were deemed candidates for reoperative cardiac surgery (RCS). They looked at 495 such patients (aged 65 ± 14, 65% of whom were men, and 47% had MV PVL) who came to the center between January 2003 and December 2011. Patients with severe mitral/aortic stenosis, PVL less than mild, and those with a prohibitive risk that precludes RCS were excluded from the study. The score of the Society of Thoracic Surgeons (STS) was calculated. The primary outcome was death.
At the start of the study, the mean STS score and left ventricular ejection fraction were (5.8 ± 4% and 52 ± 12%), respectively. A total of 105 people (21%) developed infective PVL, with 72% having moderate or severe PVL. 351 (71%) patients underwent RCS to treat PVL at a median of 8 days (3% in-hospital postoperative mortality), and 230 (47%) patients died at (6.6 ± 4) years. In a multivariable Cox survival analysis, a higher STS score (HR 1.35), mitral versus aortic PVL (HR 1.66), infectious etiology (HR 2.05), and higher right ventricular systolic pressure (HR 1.09) were all linked to a higher risk of long-term mortality, whereas surgery (HR 0.58) was linked to a lower risk of long-term mortality (all P<.05). Despite favorable perioperative results, patients who develop mild or severe PVL after AV/MV surgery have a significant probability of long-term mortality. Long-term mortality was linked to a higher STS score, right ventricular systolic pressure, viral etiology, and MV (vs. AV) involvement. In contrast, RCS for PVL closure was linked to enhanced long-term survival.
Reference:www.jtcvs.org/article/S0022-5223(18)32491-7/fulltext
