Periprosthetic leaks and valve dehiscence: alternative methods of repair.

BACKGROUND AND AIMS OF THE STUDY: Reoperations for periprosthetic leaks (PL) and valve dehiscence (VD) are associated with high mortality and substantial recurrence rate. Standard methods of repair are often not feasible due to friability of the annulus tissue or lack of space to locate the sutures. We have therefore used a variety of unconventional methods to close the leaks securely. CLINICAL MATERIAL AND METHODS: The clinical records of 25 patients reoperated for PL and VD between 1989 and 1995 were reviewed. Eighteen patients had aortic and seven mitral PL. Patients with mechanical heart valves were more frequently reoperated than those with bioprostheses (2.1% versus 0.7%). The PL was repaired in 16 cases, and the prosthesis was exchanged in nine cases with VD or large leaks. Six of the latter nine patients had active prosthetic endocarditis. A variety of surgical techniques was used to repair the leaks, including placing sutures from outside the aortic wall, through the atrial and ventricular septum, through the free left atrial wall and closure by single or double patch technique. RESULTS: Hospital 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 be useful. These methods can also be used during primary valve replacements where leaks remain.