Abstract
Introduction
A significant paravalvular leak (PVL) is estimated in at least 1–3% of patients undergoing surgical aortic and/or mitral valve replacement. Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL has emerged as an alternative to surgical repair.
Aim
We sought to examine the clinical outcomes of patients treated with percutaneous closure of PVL at an Irish tertiary referral centre.
Methods
A prospective registry was used to record patient and procedural characteristics at the time of the PVL procedure. Medical records were retrospectively reviewed to assess clinical outcomes during the index hospitalisation and at follow-up.
Results
A total of 26 PVL procedures were performed in 21 patients (mean age 68 ± 13 years, 76% male). Heart failure (HF), haemolysis (HL) or a combination of both was the presenting symptoms in 62%, 24% and 14% of patients, respectively. In the entire cohort, clinical success was achieved in 18 patients (86%). Clinical success was achieved more frequently when HF was the clinical indication compared to HL (100% versus 66%). Among patients presenting with isolated HF (n = 13), the mean NYHA class at baseline and follow-up was 2.5± 0.7 and 1.4± 0.7, respectively. Thirty-day mortality was 0%. There was one (3.8%) major adverse procedural complication (stroke). A total of six deaths (28%) occurred during follow-up (22 ± 13.4 months).
Conclusions
Patients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in those patients who present primarily with HF.
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References
Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH (2000 Oct) Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 36(4):1152–1158
Ionescu A, Fraser AG, Butchart EG (2003) Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart 89(11):1316–1321
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620
Miller DL, Morris JJ, Schaff HV et al (1995) Reoperation for aortic valve periprosthetic leakage: identification of patients at risk and results of operation. J Heart Valve Dis 4(2):160–165
Jindani A, Neville EM, Venn G et al (1991) Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg 32(4):503–508
Cho IJ, Hong GR, Lee S, Chang BC, Ha JW, Chung N (2014) Predictors of prognosis in patients with mild to moderate paravalvular leakage after mitral valve replacement. J Card Surg 29(2):149–154
Genoni M, Franzen D, Vogt P, Seifert B, Jenni R, Künzli A, Niederhäuser U, Turina M (2000) Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery? Eur J Cardiothorac Surg 17(1):14–19
Rihal CS, Sorajja P, Booker JD, Hagler DJ, Cabalka AK (2012) Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv. 5(2):121–130
Taramasso M, Maisano F, Denti P, Guidotti A, Sticchi A, Pozzoli A, Buzzatti N, de Bonis M, la Canna G, Alfieri O (2015) Surgical treatment of paravalvular leak: long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg 149(5):1270–1275
Angulo-Llanos R, Sarnago-Cebada F, Rivera AR, Elízaga Corrales J, Cuerpo G, Solis J, Gutierrez-Ibañes E, Sanz-Ruiz R, Vázquez Álvarez ME, Fernandez-Avilés F (2016 Oct) Two-year follow-up after surgical versus percutaneous paravalvular leak closure: a non-randomized analysis. Catheter Cardiovasc Interv 88(4):626–634
Wells JAT, Condado JF, Kamioka N et al (2017 Mar 13) Outcomes after paravalvular leak closure: transcatheter versus surgical approaches. JACC Cardiovasc Interv. 10(5):500–507
Sorajja P, Cabalka AK, Hagler DJ, Rihal CS (2011 Aug) Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv 4(4):314–321
Calvert PA, Northridge DB, Malik IS, Shapiro L, Ludman P, Qureshi SA, Mullen M, Henderson R, Turner M, Been M, Walsh KP, Casserly I, Morrison L, Walker NL, Thomson J, Spence MS, Mahadevan VS, Hoye A, MacCarthy PA, Daniels MJ, Clift P, Davies WR, Adamson PD, Morgan G, Aggarwal SK, Ismail Y, Ormerod JOM, Khan HR, Chandran SS, de Giovanni J, Rana BS, Ormerod O, Hildick-Smith D (2016) Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation 134(13):934–944
Taramasso M, Maisano F, Latib A, Denti P, Guidotti A, Sticchi A, Panoulas V, Giustino G, Pozzoli A, Buzzatti N, Cota L, de Bonis M, Montorfano M, Castiglioni A, Blasio A, la Canna G, Colombo A, Alfieri O (2014) Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience. Eur Heart J Cardiovasc Imaging 15(10):1161–1167
Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O’Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB (2017) Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert statement. J Am Coll Cardiol 69(16):2067–2087
Garcia E, Arzamendi D, Jimenez-Quevedo P et al (2017) Outcomes and predictors of success and complications for paravalvular leak closure: an analysis of the SpanisH real-wOrld paravalvular LEaks closure (HOLE) registry. EuroIntervention 12(16):1962–1968
Sorajja P, Cabalka AK, Hagler DJ, Rihal CS (2011 Nov 15) Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol 58(21):2218–2224
Sorajja P, Bae R, Lesser JA et al (2015) Percutaneous repair of paravalvular prosthetic regurgitation: patient selection, techniques and outcomes. Heart 101(9):665–673
Sorajja P, Cabalka AK, Hagler DJ, Rihal CS (2014) The learning curve in percutaneous repair of paravalvular prosthetic regurgitation: an analysis of 200 cases. JACC Cardiovasc Interv 7(5):521–529
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Ethical approval for this study was obtained from the Research Ethics Committee, Mater Misericordiae University Hospital (Ref: 1/378/1881 TMR).
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Tanner, R., Hassan, S., Ryan, N. et al. Trans-catheter paravalvular leak closure: a single-centre experience. Ir J Med Sci 188, 489–496 (2019). https://doi.org/10.1007/s11845-018-1895-x
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DOI: https://doi.org/10.1007/s11845-018-1895-x