Clinical analysis of reoperation for paravalvular leakage in 28 patients

Objective To observe surgical outcome of reoperation for paravalvular leakage and medium-and long-term survival. Methods The clinical data of 28 patients receiving reoperation for paravalvular leak (PVL) in General Hospital of PLA between October 1998 and October 2015. The patients included 22 males and 6 females, with a mean age of 55.3 years (ranging from 15-67 years). PVL was reported in 18 cases after mitral valve replacement, in 4 after aortic valve replacement, in 4 after multiple valve replacement (mitral PVL), in 1 case after multiple valve replacement (multiple PVL) and in 1 after radical surgery for trilogy of Fallot with tricuspid valve replacement (tricuspid PVL). There were 2 cases diagnosed as infective endocarditis contributing to PVL. The grades of heart function were NYHA Ⅱin 11 patients, NYHA Ⅲin 10, NYHA Ⅳin 7. Results Two patients died in hospital because of septic shock and MODS respectively. One patient developed hypoxic-ischemic encephalopathy after operation. There were 2 patients undergoing second thoracotomy on account of drainage post-operatively. One patient suffered recurrence of PVL. Twenty-two out of 26 patients were followed-up for 12 to 219 months (average 76.21 months) and 4 were lost to follow-up. One patient died of severe pancreatitis 31 months after hospital discharge and 1 had recurrence of PVL with heart function NYHA Ⅲ. Twenty-four survivals are in NYHA class Ⅱ. Conclusion Aggressive operation is effective treatment for moderate-severe PVL diagnosed by cardiac ultrasonography. DOI: 10.11855/j.issn.0577-7402.2016.06.1