title: Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up.
abstract: BACKGROUND
  We evaluated the incidence of paravalvular leak (PVL) after mitral valve replacement (MVR) and analyzed factors associated with early and late PVL during more than 20 years of follow-up.
  
  
  METHODS
  We studied 1,202 patients (50.4 ± 12.2 years; male/female, 456:746) who underwent MVR between 1992 and 2008. Follow-up duration was 134 months (range, 1 to 272 months). Incidence of early and late PVL was evaluated. The PVL was regarded as major if it caused hemolysis requiring multiple transfusions or regurgitant jet inducing heart failure symptoms.
  
  
  RESULTS
  In-hospital mortality rate was 4.5%. Early mitral PVL was found in 23 patients (1.9%), including 7 patients with major PVL. Late mitral PVL without obvious infection occurred in 75 patients (major PVL in 55 patients). Median interval between the index operation and major PVL was 136 months (range, 6 to 250 months). Among 55 patients with major PVL, 50 patients underwent reoperations and 5 patients were treated medically. Ten- and 20-year late mitral PVL-free rates were 96.2% and 86.9%, respectively. Ten- and 20-year major mitral PVL-free rates were 98.0% and 89.3%, respectively. Cox proportional hazard analysis revealed that age (hazard ratio, 1.052; 95% confidence interval, 1.024 to 1.079), male sex (hazard ratio, 2.804; 95% confidence interval, 1.629 to 4.828), and redo MVR (hazard ratio, 5.193; 95% confidence interval, 2.930 to 9.112) were associated with major mitral PVL during the follow-up.
  
  
  CONCLUSIONS
  Major PVL without obvious infection occurs even 20 years after MVR with 10- and 20-year major PVL-free rates of 96.2% and 86.9%, respectively. Occurrence of major PVL after MVR is more frequent in elderly, male patients and those who undergo redo MVR.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jae-Woong
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung-Hwan
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. Electronic address: ahnhyuk@snu.ac.kr.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Ahn
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D016016:Proportional Hazards Models; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery; D012307:Risk Factors; D013536:Suture Techniques