Skip to main content
SpringerLink
Log in

Paravalvular Leak in Structural Heart Disease

  • Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review will summarize the growing importance of diagnosing and managing paravalvular leak associated with surgical and transcatheter valves.

Recent Findings

The burden of paravalvular leak is increasing; however, advanced imaging techniques and high degree of clinical suspicion are required for diagnosis and management. The latest data from pivotal clinical trials in the field of transcatheter aortic valve replacement suggest that any paravalvular leak greater than mild was associated with worse clinical outcomes. Percutaneous techniques for paravalvular leak closure are now the preferred approach, and surgical repair is reserved for contraindications and unsuccessful procedures. Recent data from studies evaluating paravalvular leak closure outcomes report a greater than 90% success rate with a significant improvement in patient symptoms.

Summary

Paravalvular leak is a growing problem in the structural heart disease arena. Percutaneous closure is successful in more than 90% of the procedures with a low complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11. https://doi.org/10.1016/S0140-6736(06)69208-8.

    Article  PubMed  Google Scholar 

  2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57–185. https://doi.org/10.1016/j.jacc.2014.02.536.

    Article  PubMed  Google Scholar 

  3. Hwang HY, Choi JW, Kim HK, Kim KH, Kim KB, Ahn H. Paravalvular leak after mitral valve replacement: 20-year follow-up. Ann Thorac Surg. 2015;100(4):1347–52. https://doi.org/10.1016/j.athoracsur.2015.03.104.

    Article  PubMed  Google Scholar 

  4. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. 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. 2000;36(4):1152–8. https://doi.org/10.1016/S0735-1097(00)00834-2.

    Article  CAS  PubMed  Google Scholar 

  5. Miller DL, Morris JJ, Schaff HV, Mullany CJ, Nishimura RA, Orszulak TA. Reoperation for aortic valve periprosthetic leakage: identification of patients at risk and results of operation. J Heart Valve Dis. 1995;4(2):160–5.

    CAS  PubMed  Google Scholar 

  6. •• Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, et al. Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert statement. J Am Coll Cardiol. 2017;69(16):2067–87. https://doi.org/10.1016/j.jacc.2017.02.038. This is an expert statement regarding paravalvular leaks.

    Article  PubMed  Google Scholar 

  7. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. https://doi.org/10.1056/NEJMoa1103510.

    Article  CAS  PubMed  Google Scholar 

  8. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. https://doi.org/10.1056/NEJMoa1008232.

    Article  CAS  PubMed  Google Scholar 

  9. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–8. https://doi.org/10.1056/NEJMoa1400590.

    Article  CAS  PubMed  Google Scholar 

  10. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387(10034):2218–25. https://doi.org/10.1016/S0140-6736(16)30073-3.

    Article  PubMed  Google Scholar 

  11. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376(14):1321–31. https://doi.org/10.1056/NEJMoa1700456.

    Article  PubMed  Google Scholar 

  12. Rallidis LS, Moyssakis IE, Ikonomidis I, Nihoyannopoulos P. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J. 1999;138(2 Pt 1):351–7. https://doi.org/10.1016/S0002-8703(99)70124-9.

    Article  CAS  PubMed  Google Scholar 

  13. Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89(11):1316–21. https://doi.org/10.1136/heart.89.11.1316.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Eleid MF, Cabalka AK, Malouf JF, Sanon S, Hagler DJ, Rihal CS. Techniques and outcomes for the treatment of paravalvular leak. Circ Cardiovasc Interv. 2015;8(8):e001945. https://doi.org/10.1161/CIRCINTERVENTIONS.115.001945.

    Article  PubMed  Google Scholar 

  15. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686–95. https://doi.org/10.1056/NEJMoa1200384.

    Article  CAS  PubMed  Google Scholar 

  16. Waterbury TM, Reeder GS, Pislaru SV, Cabalka AK, Rihal CS, Eleid MF. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017;90(5):870–77.

  17. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011;58(21):2218–24. https://doi.org/10.1016/j.jacc.2011.07.041.

    Article  PubMed  Google Scholar 

  18. Millan X, Skaf S, Joseph L, Ruiz C, Garcia E, Smolka G, et al. Transcatheter reduction of paravalvular leaks: a systematic review and meta-analysis. Can J Cardiol. 2015;31(3):260–9. https://doi.org/10.1016/j.cjca.2014.12.012.

    Article  PubMed  Google Scholar 

  19. Calvert PA, Northridge DB, Malik IS, Shapiro L, Ludman P, Qureshi SA, et al. Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation. 2016;134(13):934–44. https://doi.org/10.1161/CIRCULATIONAHA.116.022684.

    Article  PubMed  Google Scholar 

  20. Genoni M, Franzen D, Vogt P, Seifert B, Jenni R, Kunzli A, et al. Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery? Eur J Cardiothorac Surg. 2000;17(1):14–9. https://doi.org/10.1016/S1010-7940(99)00358-9.

    Article  CAS  PubMed  Google Scholar 

  21. Akins CW, Bitondo JM, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks. J Heart Valve Dis. 2005;14(6):792–9. discussion 9-800

    PubMed  Google Scholar 

  22. Taramasso M, Maisano F, Denti P, Guidotti A, Sticchi A, Pozzoli A, et al. Surgical treatment of paravalvular leak: long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg. 2015;149(5):1270–5. https://doi.org/10.1016/j.jtcvs.2014.12.041.

    Article  PubMed  Google Scholar 

  23. Bouhout I, Mazine A, Ghoneim A, Millan X, El-Hamamsy I, Pellerin M, et al. Long-term results after surgical treatment of paravalvular leak in the aortic and mitral position. J Thorac Cardiovasc Surg. 2016;151(5):1260–6 e1. https://doi.org/10.1016/j.jtcvs.2015.11.046.

    Article  PubMed  Google Scholar 

  24. Wells JA, Condado JF, Kamioka N, Dong A, Ritter A, Lerakis S, et al. Outcomes after paravalvular leak closure: transcatheter versus surgical approaches. JACC Cardiovasc Interv. 2017;10(5):500–7. https://doi.org/10.1016/j.jcin.2016.11.043.

    Article  PubMed  Google Scholar 

  25. • Maor E, Raphael CE, Panaich SS, Alkhouli M, Cabalka A, Hagler DJ, et al. Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure. Catheter Cardiovasc Interv. 2017;90(5):861–9. https://doi.org/10.1002/ccd.27179. This study provides evidence regarding the importance of left atrial pressure assessment in management of mitral paravalvular leak closures.

    Article  PubMed  Google Scholar 

  26. Alkhouli M, Sarraf M, Maor E, Sanon S, Cabalka A, Eleid MF, et al. Techniques and outcomes of percutaneous aortic paravalvular leak closure. JACC Cardiovasc Interv. 2016;9(23):2416–26. https://doi.org/10.1016/j.jcin.2016.08.038.

    Article  PubMed  Google Scholar 

  27. Al-Hijji MA, Alkhouli M, Sarraf M, Zack CJ, Malouf JF, Nkomo VT, et al. Characteristics and outcomes of re-do percutaneous paravalvular leak closure. Catheter Cardiovasc Interv 2017;90(4):680–9.

  28. Ando T, Takagi H, Group A. Percutaneous closure of paravalvular regurgitation after transcatheter aortic valve implantation: a systematic review. Clin Cardiol. 2016;39(10):608–14. https://doi.org/10.1002/clc.22569.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Kashish Goel & Mackram F. Eleid

Authors
  1. Kashish Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mackram F. Eleid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mackram F. Eleid.

Ethics declarations

Conflict of Interest

Kashish Goel and Mackram F. Eleid declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Structural Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goel, K., Eleid, M.F. Paravalvular Leak in Structural Heart Disease. Curr Cardiol Rep 20, 18 (2018). https://doi.org/10.1007/s11886-018-0959-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-018-0959-x

Keywords

Search

Navigation