Title Incidence and risk factors for mitral paravalvular leak and comparison of the treatment modalities /
Translation of Title Mitralinio vožtuvo paravalvulinių fistulių susidarymo priežasčių nustatymas, jų gydymo metodų paliginimas.
Authors Zorinas, Aleksejus
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Pages 165
Keywords [eng] Mitral prosthesis ; paravalvular leak ; heart failure ; hemolysis
Abstract [eng] Introduction: Mitral paravalvular leak (PVL) is well-known complication. Repeat surgery was the only effective therapy. Recently, catheter-based PVL closure has gained global spread. The outcomes for treatment of this complication are unknown. Aim: To compare redo surgery versus surgical transapical catheter-based closure with “purpose specific” device in mitral PVL. Tasks: To determine the incidence of mitral PVL. To establish risk factors for mitral PVL. To establish early and late mortality following mitral valve replacement (MVR). To compare the early effectiveness and safety between conventional redo surgery and surgical transapical catheter-based closure for mitral PVL. Methods and patients: To determine the incidence, risk factors for mitral PVL occurrence, early and late mortality following MVR a cohort of 551 patients underwent comprehensive analysis. To compare the effectiveness and safety between two treatment modalities for mitral PVL a cohort of 73 patients was investigated. These underwent either conventional redo surgery or surgical transapical catheter-based closure procedure. Results: The incidence of mitral PVL at median follow-up of 5.5 years was 6.8 %. The relevant risk factors for the mitral PVL were the surgeon and ischemic etiology of the mitral valve lesion. In hospital (30 days) mortality after MVR was 10.7%. Five-year survival was 75% and 10-year survival was 62%. Patients with transapical catheter-based closure of mitral PVL had similar PVL closure results compared to conventional redo surgery. Also, patients after surgical transapical catheter-based closure experienced less complications compared to conventional redo surgery. Conclusions Surgical transapical catheter-based closure of mitral PVL is not inferior compared to conventional redo surgery in the effectiveness of mitral PVL reduction. Surgical transapical catheter-based closure of mitral PVL is safer in the early postoperative period compared to conventional redo surgery.
Dissertation Institution Vilniaus universitetas.
Type Doctoral thesis
Language English
Publication date 2018