title: Aortic valve periprosthetic leakage: anatomic observations and surgical results.
abstract: BACKGROUND
  One of the most frequent causes of reoperation after heart valve replacement is periprosthetic leakage (PPL). Previous studies have failed to determine whether PPL is linked to specific anatomic details. The aim of this study was to examine the location within the aortic annulus where PPL occurs, and to evaluate the postoperative outcome after surgical correction.
  
  
  METHODS
  Between January 1985 and December 2001, 28 patients underwent reoperation because of PPL after aortic valve replacement. The aortic annulus was analyzed in a clockwise format with hour 1 corresponding to the commissure between the left coronary sinus and the right coronary sinus, hour 5 to the commissure between the right coronary sinus and the noncoronary sinus, and hour 9 to the commissure between the noncoronary sinus and the left coronary sinus.
  
  
  RESULTS
  Overall operative mortality was 7.1% (2 patients). Repair of PPL was carried out in 8 patients whereas prosthetic valve replacement was necessary in 20 patients. Urgency or emergency operation (p < 0.0037), preoperative New York Heart Association class IV (p < 0.04), need for prosthetic valve replacement (p = 0.05), and implant of mechanical valve (p = 0.031) were independent determinants of dismal prognosis. Periprosthetic leakage occurred more frequently between hour 4 and hour 8 (19 patients), with the risk of leakage being two times greater than in other annular areas.
  
  
  CONCLUSIONS
  Our study suggests that PPL occurs more frequently in a specific portion of the peculiar aortic annulus. In case of PPL diagnosis, a timely reoperation might decrease operative risks by avoiding emergency procedures and unfavorable preoperative clinical conditions, and preventing prosthetic valve replacement.
authors.affiliation: Cardiac Surgery Unit, Civic Hospital, Brescia, Italy. giudeci@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Cicco
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.forename: Claudio
authors.initials: C
authors.lastname: Fragnito
authors.forename: Teresa
authors.initials: T
authors.lastname: Grimaldi
authors.forename: Bruno
authors.initials: B
authors.lastname: Borrello
authors.forename: Alessandro Maria
authors.initials: AM
authors.lastname: Budillon
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
mesh_terms: D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D004630:Emergencies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome