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Abstract

Objective: Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. Methods: A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. Results: The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. Conclusions: The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.

Keywords

surgical aortic valve replacement paravalvular leak Cor-Knot minimally invasive

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References

Thourani

VH.

Suri

RM.

Gunter

et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg 2015; 99: 55–61.doi:10.1016/j.athoracsur.2014.06.050

Kolh

Kerzmann

Honore

et al. Aortic valve surgery in octogenarians: predictive factors for operative and long-term results. Eur J Cardiothorac Surg 2007; 31: 600–606.doi:10.1016/j.ejcts.2007.01.003

Lázaro

Hinojar

Zamorano

. Cardiac imaging in prosthetic paravalvular leaks. Cardiovasc Diagn Ther 2014; 4: 307–313.doi:10.3978/j.issn.2223-3652.2014.07.01

Akins

CW.

Bitondo

JM.

Hilgenberg

et al. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks. J Heart Valve Dis 2005; 14: 799–800.

Genoni

Franzen

Vogt

et al. Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery? Eur J Cardiothorac Surg 2000; 17: 14–19.doi:10.1016/S1010-7940(99)00358-9

Kliger

Eiros

Isasti

et al. Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure. Eur Heart J 2013; 34: 638–649.doi:10.1093/eurheartj/ehs347

Taramasso

Maisano

Denti

et al. Surgical treatment of paravalvular leak: long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg 2015; 149: 1270–1275.doi:10.1016/j.jtcvs.2014.12.041

Safi

AM.

Kwan

Afflu

et al. Paravalvular regurgitation: a rare complication following valve replacement surgery. Angiology 2000; 51: 479–487.doi:10.1177/000331970005100605

Leshnower

BG.

Trace

CS.

Boova

. Port-access-assisted aortic valve replacement: a comparison of minimally invasive and conventional techniques. Heart Surg Forum 2006; 9: E560–E564.doi:10.1532/HSF98.20051111

10.

Bridgewater

Steyn

RS.

Ray

et al. Minimally invasive aortic valve replacement through a transverse sternotomy: a word of caution. Heart 1998; 79: 605–607.doi:10.1136/hrt.79.6.605

11.

Christiansen

Stypmann

Tjan

et al. Minimally-invasive versus conventional aortic valve replacement--perioperative course and mid-term results. Eur J Cardiothorac Surg 1999; 16: 647–652.doi:10.1016/S1010-7940(99)00333-4

12.

Zoghbi

WA.

Chambers

JB.

Dumesnil

et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee of the American Heart Association. J Am Soc Echocardiogr 2009; 22: 975–1014.

13.

Leffondré

Touraine

Helmer

et al. Interval-censored time-to-event and competing risk with death: is the illness-death model more accurate than the COX model? Int J Epidemiol 2013; 42: 1177–1186.doi:10.1093/ije/dyt126

14.

Delva

Touraine

Joly

et al. ADL disability and death in dementia in a French population-based cohort: new insights with an illness-death model. Alzheimer’s & Dementia 2016; 12: 909–916.doi:10.1016/j.jalz.2016.03.007

15.

Sénage

Gillaizeau

Le Tourneau

et al. Structural valve deterioration of bioprosthetic aortic valves: an underestimated complication. J Thorac Cardiovasc Surg 2019; 157: 1383–1390.doi:10.1016/j.jtcvs.2018.08.086

16.

Reardon

MJ.

Van Mieghem

NM.

Popma

et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376: 1321–1331.doi:10.1056/NEJMoa1700456

17.

Leon

MB.

Smith

CR.

Mack

et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374: 1609–1620.doi:10.1056/NEJMoa1514616

18.

O’Rourke

DJ.

Palac

RT.

Malenka

et al. Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography. J Am Coll Cardiol 2001; 38: 163–166.doi:10.1016/S0735-1097(01)01361-4

19.

Ionescu

Fraser

AG.

Butchart

. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart 2003; 89: 1316–1321.doi:10.1136/heart.89.11.1316

20.

Rallidis

LS.

Moyssakis

IE.

Ikonomidis

et al. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J 1999; 138(2 Pt 1): 351–357.doi:10.1016/S0002-8703(99)70124-9

21.

Duncan

BF.

McCarthy

PM.

Kruse

et al. Paravalvular regurgitation after conventional aortic and mitral valve replacement: a benchmark for alternative approaches. J Thorac Cardiovasc Surg 2015; 150: 860–868.doi:10.1016/j.jtcvs.2015.06.047

22.

Lee

CY.

Sauer

JS.

Gorea

et al. Comparison of strength, consistency, and speed of COR-KNOT versus manually hand-tied knots in an ex vivo minimally invasive model. Innovations 2014; 9: 111–116.doi:10.1097/imi.0000000000000051

23.

Brescia

AA.

Bolling

SF.

Patel

. Valvular regurgitation after implantation of prostheses secured with Cor-Knot automated fasteners. Ann Thorac Surg 2017; 103: e491–e492.doi:10.1016/j.athoracsur.2016.11.035

24.

Balan

Mogilansky

Larsen

et al. Severe aortic regurgitation after implantation of a sutureless valve prosthesis using an automatic knot fastener device. Interact Cardiovasc Thorac Surg 2017; 25: 153–154.doi:10.1093/icvts/ivx069

25.

Beute

TJ.

Oram

MD.

Schiller

et al. Use of an automated suture fastening device in minimally invasive aortic valve replacement. Ann Thorac Surg 2018; 106: 58–62.doi:10.1016/j.athoracsur.2018.01.073

26.

Sampaio

RO.

Silva

FCda.

Oliveira

ISde

et al. Postoperative outcome of patients with prosthetic valve leak. Arq Bras Cardiol 2009; 93: 283–289.doi:10.1590/s0066-782x2009000900013

27.

Detter

Deuse

Boehm

et al. Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement. Thorac Cardiovasc Surg 2002; 50: 337–341.doi:10.1055/s-2002-35743

28.

Kodali

SK.

Williams

MR.

Smith

et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366: 1686–1695.doi:10.1056/NEJMoa1200384

29.

Ruiz

CE.

Jelnin

Kronzon

et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol 2011; 58: 2210–2217.doi:10.1016/j.jacc.2011.03.074

30.

Waterbury

TM.

Reeder

GS.

Pislaru

et al. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 90: 870–877.doi:10.1002/ccd.27224

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Incidence,Natural History,and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

Abstract

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