PERIPROSTHETIC LEAKS AND VALVE DEHISCENCE - ALTERNATIVE METHODS OF REPAIR

Background and aims of the study: Reoperations for periprosthetic leak s (PL) and valve dehiscence (VD) are associated with high mortality an d substantial recurrence rate. Standard methods of repair are often no t feasible due to friability of the annulus tissue or lack of space to locate the sutures. We have therefore used a variety of unconventiona l methods to close the leaks securely. Clinical material and methods: The clinical records of 25 patients reoperated for PL and VD between 1 989 and 1995 were reviewed. Eighteen patients had aortic and seven mit ral FL. Patients with mechanical heart valves were more frequently reo perated than those with bioprostheses (2.1% versus 0.7%). The PL was r epaired in 16 cases, and the prosthesis was exchanged in nine cases wi th VD or large leaks. Six of the latter nine patients had active prost hetic endocarditis. A variety of surgical techniques was used to repai r the leaks, including placing sutures from outside the aortic wall, t hrough the atrial and ventricular septum, through the free left atrial wall and closure by single or double patch technique. Results: Hospit al mortality was 4% (1/25 patients) and one-year mortality 12.5%. None of the patients except one with active prosthetic endocarditis needed a second reoperation. Conclusions:If PLs are difficult to close with standard surgical technique, the alternative methods described might b e useful. These methods can also be used during primary valve replacem ents where leaks remain.