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ent. tions ral pa by E European Journal of Cardio-thoracic Supatients who received conservative therapy [1]. The choice of operation involves repair of the leak or re-replacement of the valve, and depends on the surgical findings related to etiology, condition of the native mitral annulus, location and size of the leak, and surgical exposure. Either repair of the leak or re-replacement of the valve poses a technical challenge as failure rates can be up to 35%. Many techniques have been described to repair mitral paravalvular leaks, including direct suturing, use of patches, and incorporation of healthy full-thickness autologous tissue [2,3]. Along the same principles as using full-thickness autologous tissue, w