71. Incidence of paravalvular leakage after aortic and mitral valve replacement at KFSH & RS, single centre experience

Abstract

Paravalvular leakage (PVL) is not rare and can be a serious clinical problem in 1–5% of all valve replacement. There are inconclusive data regarding the incidence of PVR after aortic valve replacement (AVR) and mitral valve replacement (MVR).The aim of this study was to review PVL based upon more than ten years experience from King Faisal Specialist Hospital & Research Centre. Method: Retrospective analysis of the consecutive adult patients that underwent surgical valve replacement between January 2000 and December 2011. Results: During the period of 12 years (January 2000 through December 2011), prosthetic valve replacement surgery was performed in 2060 patients, aortic valve replacement (AVR) in 655, mitral valve replacement (MVR) in 1048 and combined AVR and MVR in 357 patients. From echocardiography database we found significantly higher incidence of PVL after combine AVR + MVR (n = 48; 13.45% than isolated MVR (n = 46; 4.38%) and AVR (n = 29; 4.43%). Mechanical valve was implanted in 82 cases and bioprosthesis in 41 cases. Initial VR was performed in 55% of patients (n = 68). First re-do has been done in 32 patients (26%), second-, third- and forth reoperation were performed in 11 (8.9%), 9 (7.3%) and 3 (2.4%) patients, respectively. Mild to moderate PVL was diagnosed in 90 cases (73%) and 33 (27%) patients had moderate to severe PVR according TTE. It was significantly higher percentage of moderate and severe PVR after MVR than AVR (p = 0.025). There was significantly higher incidence of reoperation in mitral then aortic position (p = 0.037). Conclusion: Paravalvular leakage after mitral valve replacement is severe and has a more detrimental clinical outcome compared to that after aortic valve replacement. Incidence of PVL is significantly higher after combine valve replacement than single valve replacement.