Valeur pronostique des fuites paraprothétiques aseptiques après remplacement valvulaire mitral par une prothèse Saint Jude Médical (SJM)

Abstract

Periprosthetic regurgitation (PPR) is a common complication of mitral valve replacement (MVR). The management of moderate and minor PPR remains controversial. The goal of this prospective study was to determine the incidence, predictors and outcome of PPR discovered using omniplan transœsophageal echocardiography (TEE) performed at the early postoperative period (14.7 days) of MVR with SJM prosthesis. Our study enrolled 56 patients, the mean age was 44.5 ±11.9 years. The incidence of PPR was 59% (33 patients). TEE showed one jet in nine patients (27%), two jets in 23 patients (70%) and three jets in one patient (3%). PPR is minor in 24 patients (63%) and moderate in nine patients (27%). No patient developed hemolytic anemia or congestive heart failure. In univariate analysis, diameter of prostheses >27 mm, number of suture knots <17 and diameter of prostheses/number of knot ratio >1.7 independently predicted the presence of PPR. In multivariate analysis only a rapport diameter of protheses/number of suture knots >1.7 mm is predictif of PPR (odd ratio =9, P =0.036). Ninety percent of PPR remained present at six weeks and only 29% were present after 12.5 months. Conclusion: mild and minor PPR were frequent during the early postoperative period after MVR. The clinical significance and natural history is benign and they do not require any specific treatment.