Postoperative outcome of patients with prosthetic valve leak.

BACKGROUND Prosthetic valve leak is a possible complication of surgical valve replacement. Although uncommon, its consequences may be serious. Few studies correlate the degree of prosthetic valve leak with clinical events. OBJECTIVE To compare the postoperative outcome of patients with mild/moderate (Mi/Mo) or severe (Sev) prosthetic valve leak METHODS A total of 185 patients with prosthetic valve leak were selected among 1350 patients undergoing heart valve surgery between 1999 and 2001. Of these, a sample of 58 patients (37 men) with prosthetic valve leak (36 with Mi/Mo versus 22 with Sev leak) in the pre and/or postoperative period of heart valve replacement had complete medical record data, so their clinical, laboratory and echocardiographic data could be retrospectively assessed. RESULTS The incidence of reoperation was 11.1% in the Mi/Mo group, versus 22.7% in the Sev group (odds ratio = 2.35 [95% CI 0.56-9.94]). Endocarditis was the cause of reoperation in 75% of the patients of the Mi/Mo group and in 60% of the Sev group. Aortic bioprostheses were those most frequently related to leak (55.8% in the Mi/Mo group and 57.7% in the Sev group). Forty percent of the patients with previous Mi/Mo leak did not present prosthetic valve leak on postoperative day 2 versus 21.4% of the patients with Sev prosthetic valve leak. No significant differences were found regarding laboratory variables. CONCLUSIONS (1) Patients with severe leak are more likely to undergo reoperation. (2) Endocarditis was the most frequent cause of reoperation for any leak degree. (3) Severe prosthetic valve leak is more difficult to fully resolve after surgical treatment.