title: Long-term results of surgical correction for mitral paravalvular leak: repair versus re-replacement.
abstract: OBJECTIVE
  Paravalvular leak (PVL) is a common clinical manifestation after cardiac valve replacement. The results of surgical management for mitral PVL were evaluated and compared according to the surgery employed.
  
  
  METHODS
  Between September 1995 and September 2009, a total of 52 patients (30 males, 22 females; mean age 57.2 +/- 13.0 years) underwent surgery for mitral PVL. Thirty-five patients (67.3%) underwent multiple cardiac surgeries more than once. PVL was treated with leak site repair in 22 patients (group I) and re-replacement of the mitral valve in 30 patients (group II). Concomitant operations were performed in 34 patients (65.4%). The mean duration of follow up was 57.4 +/- 39.4 months.
  
  
  RESULTS
  There were six (11.5%) in-hospital deaths. Postoperative complications occurred in 19 patients, including low cardiac output syndrome (n = 7). There were no differences in early results between the two groups. The presence of more than moderate tricuspid regurgitation was the only risk factor for in-hospital mortality to reach statistical significance (p = 0.023). During the follow up period, late death occurred in 11 patients, including four cardiac deaths. The 10-year overall survival rate was 57.8%, without intergroup difference (p = 0.699). PVL recurred in 10 patients; the mean rate of freedom from recurrence of PVL was 67.7% at 10 years, and the five- and 10-year major valve-related event-free survival rates were 55.5% and 31.8%, respectively. There were no differences in freedom from recurrence of PVL (p = 0.346) and valve-related event-free survival (p = 0.824) between the two groups.
  
  
  CONCLUSIONS
  The surgical treatment of mitral PVL proved to be acceptable when considering the high-risk profile of the patients. However, because of the similar outcomes after leak site repair and re-replacement, a more effective method might be selected on an individual basis when considering the surgical correction of mitral PVL.
authors.affiliation: Seoul National University Hospital, Jongno-gu, Seoul, Korea.
authors.forename: Jae-Woong
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Seoul National University Hospital, Jongno-gu, Seoul, Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Seoul National University Hospital, Jongno-gu, Seoul, Korea.
authors.forename: Kyung-Hwan
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital, Jongno-gu, Seoul, Korea.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital, Jongno-gu, Seoul, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Ahn
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome