Surgical Correction of Prosthetic Mitral Valve Paravalvular Leak: Analysis of Long-Term Outcomes

Background: Paravalvular leak involving a prosthetic mitral valve (M-PVL) is a rare but serious complication after mitral valve replacement (MVR). This study evaluated contemporary outcomes after surgical correction of M-PVL and investigated factors associated with its recurrence. Methods: This retrospective study included 199 patients who underwent first-time surgical correction of M-PVL between 2002 and 2023 (mean age, 64.5±9.6 years; 55.8% female). Early and long-term outcomes, including all-cause mortality and recurrence, were analyzed using Cox proportional hazards and cause-specific hazards models. The median follow-up duration was 55.9 months (interquartile range, 30.3-96.4 months). Results: Seventy-two percent of the patients had undergone at least 2 previous open-heart operations. The most common concomitant procedures were tricuspid valve surgery (n=78; 39.2%) and aortic valve surgery (n=48; 24.1%). Leak site repair was performed in 81 patients (40.7%), and redo MVR was performed in 118 patients (59.3%). The overall operative mortality rate was 6.0% (n=12) and decreased over time from 12.5% to 2.5%. The 5- and 10-year all-cause mortality rates were 20.7% and 38.4%, respectively. Cox proportional hazards analysis identified several preoperative and operative factors, including the era of operation, that were associated with all-cause mortality. The cumulative incidence of recurrent M-PVL was 10.0% at 5 years and 36.2% at 10 years. Cause-specific hazards analysis identified no factors significantly associated with recurrent M-PVL. Outcomes did not differ significantly between leak site repair and redo MVR. Conclusion: Early outcomes after surgical correction of M-PVL improved over the study period. However, recurrence remained common regardless of operative technique.