Recurrent mitral paravalvular leak: Benefits of leak site repair compared to re-replacement

Mitral paravalvular leak (PVL) recurrence after surgical correction has not been well demonstrated. The aims of this study were to evaluate the long-term results of surgical mitral PVL correction, including recurrent PVL, and to elucidate the factors - including surgical technique - that affect the risk of recurrent PVL.Eighty-six patients who underwent surgical treatment for mitral PVL were enrolled in this study. Thirty-six patients underwent leak site repair (MVP group), and 50 patients underwent re-replacement (MVR group). Leak site repair was the preferred method and was performed whenever possible. The mean follow-up duration was 58.6±44.1 months (0.1-156.5 months).Operative mortality occurred in 7 patients (8.1%). There were no significant differences in operative mortality or postoperative complications between the groups. Overall survival rates at 5 and 10 years were 67.9% and 48.3%, respectively, without intergroup differences. Recurrent PVL without any evidence of infective endocarditis was found in 25 patients (29.1%). Five- and 10-year PVL-free rates were 69.9% and 18.3%, respectively. The mortality rate of reoperation for recurrent PVL was 35.2% (6/17). The risk factors of recurrent PVL were the MVR group (hazard ratio: 2.865, 95% CI: 1.077-7.619) and presence of extensive dehiscence (>25% of annulus: 2.861, 95% CI: 1.163-7.038).Recurrent PVL was not infrequent after surgical correction of mitral PVL, and reoperation may be a high-risk procedure. Leak site repair, if it could be performed, would be a good surgical option for mitral PVL because re-replacement was a risk factor for recurrence of PVL.