This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O’Rourke, D. J. Articles by Plehn, J. F. Search for Related Content PubMed PubMed Citation Articles by O’Rourke, D. J. Articles by Plehn, J. F.

CLINICAL STUDY

Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography

Daniel J. O’Rourke, MD, MS, FACC^*, Robert T. Palac, MD, MS, FACC, David J. Malenka, MD, FACC, Charles A. S. Marrin, MB, BS, Brenda E. Arbuckle, BA and Jonathan F. Plehn, MD, FACC

^* Section of Cardiology, Veterans Affairs Hospital, White River Junction, Vermont, USA
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Research and Education, St. Francis Hospital, Roslyn, New York, USA

Manuscript received December 19, 2000; revised manuscript received March 21, 2001, accepted April 5, 2001.

Reprint requests and correspondence: Dr. Daniel J. O’Rourke, Section of Cardiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756
Daniel.O'Rourke{at}Hitchcock.org

OBJECTIVES

The goal of this study was to determine the outcome of trivial or mild periprosthetic regurgitation (PPR) identified by intraoperative transesophageal echocardiography (TEE).

BACKGROUND

The clinical significance, natural history and correlates of trivial or mild PPR detected early after surgery are unknown.

METHODS

Between 1992 and 1997, 608 consecutive patients underwent isolated aortic valve replacement or mitral valve replacement at Dartmouth-Hitchcock Medical Center. Of these, 113 patients (18.3%) were found to have trivial or mild PPR at surgery by TEE. Follow-up transthoracic echocardiograms (early TTEs) were obtained within six weeks of surgery in 99.0% of patients and late TTEs (mean 2.1 years) in 54.3%. Clinical, intraoperative and outcome variables associated with PPR were identified using t test, chi-square and logistic regression analyses.

RESULTS

By univariate analysis, compared with patients without PPR, patients with PPR were older, of smaller body surface area (BSA), had degenerative valve disease more often and were more likely to receive a bioprosthetic valve. By multivariate analysis, smaller BSA and the use of a bioprosthesis were the strongest predictors of PPR (p < 0.01). At early TTE, PPR was not observed (n = 56) or remained unchanged (n = 44) in all patients. At late TTE, four patients were found to have progression of their PPR. All four patients had bioprosthetic valves. Two of these patients had endocarditis, and one had primary valvular degeneration. The fourth patient had progressive PPR.

CONCLUSIONS

Trivial or mild PPR is a frequent finding on intraoperative TEE. Smaller body size and the use of a bioprosthetic valve are significantly associated with PPR. The clinical significance and natural history of PPR is benign in most cases.

Abbreviations and Acronyms   AVR = aortic valve replacement   BSA = body surface area   MVR = mitral valve replacement   PPR = periprosthetic regurgitation   TEE = transesophageal echocardiography   TTE = transthoracic echocardiography

This article has been cited by other articles:

				D. Detaint, L. Lepage, D. Himbert, E. Brochet, D. Messika-Zeitoun, B. Iung, and A. Vahanian Determinants of Significant Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation: Impact of Device and Annulus Discongruence J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 821 - 827. [Abstract] [Full Text] [PDF]

				M.-A. Clavel, J. G. Webb, P. Pibarot, L. Altwegg, E. Dumont, C. Thompson, R. De Larochelliere, D. Doyle, J.-B. Masson, S. Bergeron, et al. Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1883 - 1891. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management Circulation, February 24, 2009; 119(7): 1034 - 1048. [Full Text] [PDF]

				L. Englberger, H. V. Schaff, W.R. E. Jamieson, E. D. Kennard, K. A. Im, R. Holubkov, T. P. Carrel, and for the AVERT Investigators Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT) Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 838 - 843. [Abstract] [Full Text] [PDF]

				V. G. Davila-Roman, A. D. Waggoner, E. D. Kennard, R. Holubkov, W. R. E. Jamieson, L. Englberger, T. P. Carrel, and H. V. Schaff Prevalence and severity of paravalvular regurgitation in the Artificial Valve Endocarditis Reduction Trial (AVERT) echocardiography study J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1467 - 1472. [Abstract] [Full Text] [PDF]

				Y. Shapira, M. Vaturi, D. E. Weisenberg, E. Raanani, G. Sahar, E. Snir, A. Battler, B. A. Vidne, and A. Sagie Impact of intraoperative transesophageal echocardiography in patients undergoing valve replacement Ann. Thorac. Surg., August 1, 2004; 78(2): 579 - 583. [Abstract] [Full Text] [PDF]