title: Long-term results after surgical treatment of paravalvular leak in the aortic and mitral position.
abstract: OBJECTIVE
  The aim of this study was to determine immediate results and long-term outcomes after surgical management of paravalvular leak (PVL).
  
  
  METHODS
  Between 1995 and 2012, a total of 190 patients underwent primary surgical repair (n = 142) or valve replacement (n = 48) for a PVL at our institution. The PVL was mild in 6 (3%) patients, moderate in 85 (45%), moderate to severe in 84 (44%), and severe in 15 (8%). Among these, 120 (63%) had PVL in the mitral position, 63 (33%) had PVL in the aortic position, and 7 (4%) had PVL in both valves. Mean follow-up was 5.3 ± 4.6 years.
  
  
  RESULTS
  Mean age at surgery was 63 ± 12 years (64% men). Operative mortality occurred in 13 (7%) patients (10 [8%] in mitral; 2 [3%] in aortic; and 1 [14%] in double valve procedures). Survival at 1, 5, and 10 years was 85% ± 3%, 73% ± 4%, and 56% ± 5%, respectively. The cumulative incidence of PVL recurrence was 3% ± 1%, 14% ± 3%, and 32% ± 6%, at 1, 5, and 10 years, respectively. The number of previous surgeries was a predictor of survival and PVL recurrence. Freedom from New York Heart Association class ≥III was 96% ± 2%, 82% ± 4%, and 58% ± 6%, at 1, 5, and 10 years, respectively. The freedom from rehospitalization for heart failure was 92% ± 2%, 83% ± 4%, and 67% ± 6%, at 1, 5, and 10 years.
  
  
  CONCLUSIONS
  Surgical treatment of PVL resulted in acceptable outcomes. Nevertheless, the continued risk of PVL recurrence is higher in patients who have had multiple previous surgeries. More studies are needed to compare these results with the transcatheter PVL reduction technique.
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: Bouhout
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Aly
authors.initials: A
authors.lastname: Ghoneim
authors.affiliation: Department of Interventional Cardiology, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Xavi
authors.initials: X
authors.lastname: Millàn
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal School of Medicine, Quebec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000503:physiopathology; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic valve; heart valve replacement; mitral valve; paravalvular leak; redo surgery