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Researchers report low incidence of paravalvular leak following surgical aortic valve replacement

October 21, 2019 Research News

Among 636 patients who underwent surgical aortic valve replacement (SAVR) at Lankenau Heart Institute between 2006 and 2016, only 1.4 percent developed intraoperative paravalvular leak (PVL), according to a new study. That incidence of intraoperative PVL is one of the lowest reported in the literature, noted the study’s authors.

PVL, an abnormal leak around a patient’s prosthetic valve, may lead to heart failure, reoperation or death.

During the study, minimally invasive aortic valve replacement was performed in 410 (64.5 percent) of the 636 patients. In the cohort of 410 patients, postoperative PVL incidence was 4.4 percent at one year in the patients who had sutures that were hand-tied. Meanwhile, among patients who underwent suture tying with Cor-Knot, an automated suture-fastener, the cumulative incidence of postoperative PVL was lower: 1.9 percent at one year.

In this retrospective study, the authors also found that renal failure was a factor significantly associated with postoperative PVL.

“The study is important because it demonstrates the incidence of paravalvular leak in a large contemporary series of SAVRs in the transcatheter era,” said Konstadinos Plestis, MD, the study’s senior author.

Vishal Shah, DO, fifth year general surgery resident at Lankenau and the study’s lead author, noted that the hospital has been at the forefront of minimally invasive cardiac surgery over the past decade. “By publishing our excellent outcomes, we hope to demonstrate that minimally invasive aortic valve replacement is safe and reproducible, particularly with the use of innovative technology,” said Dr. Shah.

The study, “Incidence, Natural History, and Factors Associated with Paravalvular Leak Following Surgical Aortic Valve Replacement,” was published in the October issue of the biomedical journal Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, the official journal of the International Society for Minimally Invasive Cardiothoracic Surgery.

Other Main Line Health authors included Scott Goldman, MD; Matthew Thomas, MD; and Serge Sicouri, MD; as well as Meghan Buckley, MS, biostatistician at the Lankenau Institute for Medical Research.

Disclosure: Dr. Shah reports receiving research funding from LSI Solutions, the manufacturer of Cor-Knot.

About Main Line Health

Founded in 1985, Main Line Health is a not-for-profit health system serving Philadelphia and its western suburbs. Main Line Health's commitment—to deliver advanced medicine for treating and curing disease, playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to be the region's premier choice for clinical care, research, and education. A team of more than 10,000 employees, 3,000 nurses and 2,000 physicians care for patients throughout the Main Line Health System.

At Main Line Health's core are four of the region's most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation's premier facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.

Main Line Health also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton, King of Prussia and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare, one of the region's largest multispecialty physician networks.

Main Line Health is the recipient of numerous awards for quality care, and service, including U.S. News & World Report's Best Hospitals, System Magnet® designation; the nation's highest distinction for nursing excellence and the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award. Main Line Health is committed to creating an environment of diversity, respect, equity, and inclusion, has proudly received awards in this area and has embraced the American Hospital Association's #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education, and research to help patients stay healthy and live their best lives.

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About Lankenau Institute for Medical Research

Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR's mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR's principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.