Abstract
The incidence of aortic paravalvular leaks after surgical valve replacement is estimated to be 2-17%. Aortic paravalvular leaks (PVL) can be asymptomatic and not require treatment or can cause haemolysis or heart failure. If symptomatic or if the severity of the leak is moderate or severe, redo surgery is a therapeutic option, but this is normally accompanied by consistent perioperative risk. A lower risk alternative is percutaneous PVL closure, with a 1-2% risk of periprocedural death or need for reoperation. These procedures are can be very challenging, with a reported rate of procedural success around 80%. This requires that better technical solutions become available in the future. Currently, aortic PVLs are approached with a retrograde transarterial approach, with a dedicated AMPLATZER device. Multimodality imaging planning is key while intraoperative fusion imaging can play a major role to identify the leak.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Genoni M, et al. Paravalvular leakage after mitral valve replacement: improved long-term survival with aggressive surgery? Eur J Cardiothorac Surg. 2000;17:14–9.
Hammermeister K, et al. 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;36:1152–8.
Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89:1316–21.
Jindani A, et al. Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg. 1991;32(4):503–8.
Miller DL, et al. Reoperation for aortic valve periprosthetic leakage: identification of patients at risk and results of operation. J Heart Valve Dis. 1995;4:160–5.
Nishida T, et al. Single-institution, 22-year follow-up of 786 CarboMedics mechanical valves used for both primary surgery and reoperation. J Thorac Cardiovasc Surg. 2014;147:1493–8.
LaPar DJ, et al. Outcomes of reoperative aortic valve replacement after previous sternotomy. J Thorac Cardiovasc Surg. 2010;139:263–72.
Dennis Kasper, et al. Harrison’s principles of internal medicine. 19th ed. New York: McGraw-Hill; 2015.
De Cicco G, et al. Aortic valve periprosthetic leakage: anatomic observations and surgical results. Ann Thorac Surg. 2005;79:1480–5.
Lytle BW, et al. Surgical treatment of prosthetic valve endocarditis. J Thorac Cardiovasc Surg. 1996;111:198–207.
Rallidis LS, et al. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J. 1999;138:351–7.
Wasowicz M, et al. Early complications and immediate postoperative outcomes of paravalvular leaks after valve replacement surgery. J Cardiothorac Vasc Anesth. 2011;25:610–4.
Gordon SM, et al. Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997. Ann Thorac Surg. 2000;69:1388–92.
Lancellotti P, et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:589–90.
Zoghbi WA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.
Sinning JM, et al. Evaluation and management of paravalvular aortic regurgitation after transcatheter aortic valve replacement. J Am Coll Cardiol. 2013;62:11–20.
Suh YJ, et al. Assessment of mitral paravalvular leakage after mitral valve replacement using cardiac computed tomography: comparison with surgical findings. Circ Cardiovasc Imaging. 2016;9:e004153.
Alkhouli M, et al. Techniques and outcomes of percutaneous aortic paravalvular leak closure. JACC Cardiovasc Interv. 2016;9:2416–26.
Thaden JJ, et al. Echocardiographic and fluoroscopic fusion imaging for procedural guidance: an overview and early clinical experience. J Am Soc Echocardiogr. 2016;29:503–12.
Bouhout I, et al. Long-term results after surgical treatment of paravalvular leak in the aortic and mitral position. J Thorac Cardiovasc Surg. 2016;151:1260–6.
Taramasso M, et al. Surgical treatment of paravalvular leak: long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg. 2015;149:1270–5.
Taramasso M, et al. 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. 2014;15:1161–7.
Binder RK, Webb JG. Percutaneous mitral and aortic paravalvular leak repair: indications, current application, and future directions. Curr Cardiol Rep. 2013;15:342.
Wells JA, et al. Outcomes after paravalvular leak closure: Transcatheter versus surgical approaches. JACC Cardiovasc Interv. 2017;10:500–7.
Smolka G, et al. Multiplug paravalvular leak closure using Amplatzer Vascular Plugs III: A prospective registry. Catheter Cardiovasc Interv. 2016;87:478–87.
Goktekin O, et al. Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder. EuroIntervention. 2016;11:1195–200.
Nietlispach F, et al. Transcatheter closure of paravalvular defects using a purpose-specific occluder. JACC Cardiovasc Interv. 2010;3:759–65.
Cruz-Gonzalez I, et al. Paravalvular leak closure with the Amplatzer vascular plug III device: immediate and short-term results. Rev Esp Cardiol (Engl Ed). 2014;67:608–14.
Calvert PA, et al. Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation. 2016;134:934–44.
Taramasso M, et al. Catheter-based treatment of paravalvular leaks. EuroIntervention. 2016;12:S55–60.
Smith CR, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.
Luu J, et al. Percutaneous closure of paravalvular leak after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2013;6:6–8.
Okuyama K, et al. Percutaneous paravalvular leak closure for balloon-expandable transcatheter aortic valve replacement: a comparison with surgical aortic valve replacement paravalvular leak closure. J Invasive Cardiol. 2015;27:284–90.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer-Verlag GmbH Austria, part of Springer Nature
About this chapter
Cite this chapter
Pozzoli, A. et al. (2019). Management of Aortic Prosthetic Leaks. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_49
Download citation
DOI: https://doi.org/10.1007/978-3-7091-4874-7_49
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-4872-3
Online ISBN: 978-3-7091-4874-7
eBook Packages: MedicineMedicine (R0)