Abstract 13900: Impact of Paravalvular Leak
OBJECTIVE Mild to moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients.
METHODS Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have residual AR >1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and its impact on survival were assessed by multivariate analysis.
RESULTS Mean follow up was 4.5±3.4 years. The use of a bioprosthesis, longer CPB duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified co-morbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of >1/4 residual AR. Survival in the latter group was lower than for patients with ≤1/4 AR at all time points; 91.4% vs 96.7%, 77.5% vs 82.4% and 44.1% vs 54.5% at 1, 5 and 10 years, respectively (p<0.01).
CONCLUSIONS Postoperative residual AR >1/4 is an independent predictor of postoperative mortality, and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.
- © 2011 by American Heart Association, Inc.