Echocardiographic characteristics of paravalvular leak following surgical aortic valve replacement: a retrospective cohort study.

BACKGROUND

Paravalvular leak (PVL) is a recognized complication following surgical aortic valve replacement (SAVR), with a reported incidence ranging from 1% to 10%. Although some patients with mild PVL remain asymptomatic, others may develop clinically significant complications such as heart failure or hemolysis, underscoring the importance of early detection and timely intervention. While previous research has largely emphasized the risk factors and prognostic implications of PVL, limited literature focuses on the detailed echocardiographic characteristics of both the native aortic valve prior to SAVR and the PVL itself following surgery. Therefore, the objective of this study was to investigate the echocardiographic features of PVL after SAVR-specifically its origin, severity, and correlation with the calcified location of the preprocedural aortic valve.

METHODS

This retrospective cohort study, conducted at a single academic institution, investigated all SAVR procedures performed from June 2010 to October 2022. PVL was identified using intraoperative transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) within 1 year postoperatively. The echocardiographic characteristics of PVL after SAVR, including its origin and severity, as well as its correlation to the calcified location of the preprocedural aortic valve, were investigated along with the incidence.

RESULTS

Of the total 948 SAVR cases, PVL was identified in 77 (8.1%) intra- and/or postoperatively. Ten of the 77 cases were excluded from the analysis due to missing stored echocardiographic images, resulting in 67 PVL cases being investigated. The origin of PVL was identified in 62 cases on a short-axis (SAX) view of the aortic valve, with the most common site being the mid-portion of right coronary cusp (RCC) of the native aortic valve position in 22 cases (35.5%), followed by the non-coronary cusp (NCC) and the left coronary cusp (LCC), each in 12 cases (19.4%). Calcification of the preprocedural native aortic valve, ranging from mild to severe, was observed in 38 cases (56.7%). Among these 38 cases with a calcified native valve, the location of PVL was identified in 36 cases, showing a significant correlation between the location of calcification and the position of PVL (r=0.74, P<0.001). Of the 67 PVL cases detected intraoperatively and/or postoperatively, severity was mild in 58 cases (86.6%) and moderate in 9 cases (13.4%), with no severe cases.

CONCLUSIONS

PVL following SAVR was observed in 8.1% of cases either intraoperatively or within the first year postoperatively. The majority of PVL cases were mild in severity. The most common site of PVL was the mid-portion of the RCC at the native aortic valve position. A significant correlation was found between the location of calcification in the preoperative native valve and the site of PVL.