title: Surgical treatment of paravalvular leak: Long-term results in a single-center experience (up to 14 years).
abstract: OBJECTIVE
  The aim of this study is to report the long-term outcomes (median follow-up time, 7 years; range, 1 month to 14 years) of patients who underwent surgery for paravalvular leak in our single-center experience.
  
  
  METHODS
  From October 2000 to November 2007, 122 consecutive patients underwent surgery for symptomatic paravalvular leak (40 patients with aortic paravalvular leak; 82 with mitral paravalvular leak). In 7 patients (5.7%, all mitral), surgery was performed on the beating heart through a right thoracotomy. In 35% of patients, multiple paravalvular leaks were present.
  
  
  RESULTS
  The mean age of patients was 62 ± 11 years, and European System for Cardiac Operative Risk Evaluation II was 7.2% ± 6%. Most of the patients were in New York Heart Association functional class III or IV (60%). Symptomatic hemolysis was present in 31% of the patients, and 41% of the patients had more than 1 previous cardiac operation. Paravalvular leak repair was feasible in 79 patients (65%), whereas in 43 patients (35%) prosthesis re-replacement was required. Thirty-day mortality was 10.7% (13/122 patients; 5% for aortic paravalvular leak and 13% for mitral paravalvular leak; P = .1); 2 patients (1.6%) with residual severe mitral paravalvular leak underwent successful redo surgery before discharge. Median length of stay was 7 days. Overall actuarial survival was 39% ± 6% at 12 years; freedom from cardiac death was 54% ± 7% at 12 years. Only 1 patient underwent redo surgery during follow-up. Multivariable analysis identified preoperative chronic renal failure (hazard ratio, 2.6; 95% confidence interval, 1.4-4.9; P = .03) and more than 1 previous cardiac reoperation (hazard ratio, 2.3; 95% confidence interval, 1.3-4; P = .03) as independent predictors of death at follow-up.
  
  
  CONCLUSIONS
  The operative mortality of surgical treatment of paravalvular leak is still high. Long-term outcomes remain suboptimal in these challenging patients, especially in the presence of multiple previous cardiac operations and associated co-pathologies. These results support the importance of alternative therapeutic options.
authors: Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland; Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy. Electronic address: Maurizio.Taramasso@usz.ch.
authors: Maurizio
authors: M
authors: Taramasso
authors: Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland.
authors: Francesco
authors: F
authors: Maisano
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Paolo
authors: P
authors: Denti
authors: Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland.
authors: Andrea
authors: A
authors: Guidotti
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Alessandro
authors: A
authors: Sticchi
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Alberto
authors: A
authors: Pozzoli
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Nicola
authors: N
authors: Buzzatti
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Michele
authors: M
authors: De Bonis
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Giovanni
authors: G
authors: La Canna
authors: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors: Ottavio
authors: O
authors: Alfieri
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome