mohamed elghanam, Mohamed Zeinah


OBJECTIVES: To evaluate the incidence of paravalvular leaks (PVLs) after surgical aortic valve replacement (AVR) and assess its impact on postoperative outcomes.

METHODS: A retrospective review of 460 consecutive isolated AVR from January 2008 to December 2014. Postoperative transthoracic echocardiograms (TTE) and clinical notes were reviewed.

RESULTS: Thirty-five patients (7.6%) developed a PVL and formed the cohort of this report. TTE grading of PVL was trivial in 18 (51.4%), mild in 14 (40%), moderate in 2 (5.7%) and severe in 1 patient (2.9%), with an overall prevalence of developing moderate to severe PVL after AVR of 0.065%. Mean age was 63 years, 23 patients were males (65.7%) and mean logistic Euroscore was 8.35 + 15.8%. Valve lesions were mainly stenosis (24 patients; 68.6%), regurgitation (7 patients; 20%) and mixed aortic lesions (4 patients; 11.4%). Implanted prostheses were 19 bioprosthesis  (54.2%) and 16 mechanical valves  (45.8%). We had one 30-days mortality (2.8%), 13 postoperative new onset atrial fibrillation (37%), permanent pacemaker 2.8%, cerebrovascular stroke 2.8%, re sternotomy for bleeding 2.8% and two patients needed hemodialysis (5.7%). Patients were followed up for 0.9 + 1.2 years. When last seen, 27 patients were in NYHA class I (77.1%), six patients were in class II (17.1%) and two patients with moderate to severe PVL remained in NYHA class IV (5.7%). Peak aortic valve gradients ranged from 14 to 68 mmHg, with a mean gradient of 27.8 + 13.3 mm Hg. Three patients with trivial PVL (8.5%) developed prosthetic valve endocarditis, with 2 patients among them requiring intervention for prosthetic valve failure (5.7%). Demographics, preoperative risk profiles and hospital outcomes were comparable to those recorded in the remaining 425 patients without PVL.

CONCLUSION: The incidence of PVL after conventional AVR is small and the development of moderate or greater leaks is negligible. Trivial to mild leaks had a benign course unless complicated by PVE. New percutaneous therapies for aortic valve disease must match these low rates.

Key words: Paravalvular leak, prosthetic valve dysfunction, aortic valve.

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