title: Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience.
abstract: Most mitral paravalvular leaks (PVLs) occur during the first year after mitral valve replacement (MVR). This report describes the surgical management of 6 patients who developed very late mitral PVLs. The median interval between MVR and initial diagnosis of PVL was 16.5 years. All patients presented with congestive cardiac failure and haemolytic anaemia. The median EuroSCORE II was 9.5%. Two patients (33%) had failed attempts at transcatheter closure. Five patients underwent suture repair of the PVL. One patient underwent MVR after removal of the previous prosthesis. No in-hospital mortalities occurred. At latest follow-up (median 3.3 years), 5 patients (83%) were asymptomatic with no residual PVL. Haemolytic anaemia persisted in 1 patient with a mild residual PVL. PVL occurring decades after MVR is a rare but serious complication. Reoperative surgery can be performed in these high-risk patients with satisfactory early and midterm outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
authors.forename: Philip Y K
authors.initials: PY
authors.lastname: Pang
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
authors.forename: Jiasi
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
authors.forename: Yoong Kong
authors.initials: YK
authors.lastname: Sin
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
authors.forename: Yeow Leng
authors.initials: YL
authors.lastname: Chua
keywords: Heart valve prosthesis; mitral valve replacement (MVR); paravalvular leak (PVL)