Advertisement

Management of Aortic Prosthetic Leaks

  • Alberto PozzoliEmail author
  • Maurizio Taramasso
  • Michel Zuber
  • Shingo Kuwata
  • André Plass
  • Marco Russo
  • Fabian Nietlispach
  • Francesco Maisano
Chapter

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.

Keywords

Aortic regurgitation Aortic paravalvular leak Multimodality imaging Surgical repair Transcatheter closure 

References

  1. 1.
    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.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    Jindani A, et al. Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg. 1991;32(4):503–8.Google Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    LaPar DJ, et al. Outcomes of reoperative aortic valve replacement after previous sternotomy. J Thorac Cardiovasc Surg. 2010;139:263–72.CrossRefGoogle Scholar
  8. 8.
    Dennis Kasper, et al. Harrison’s principles of internal medicine. 19th ed. New York: McGraw-Hill; 2015.Google Scholar
  9. 9.
    De Cicco G, et al. Aortic valve periprosthetic leakage: anatomic observations and surgical results. Ann Thorac Surg. 2005;79:1480–5.CrossRefGoogle Scholar
  10. 10.
    Lytle BW, et al. Surgical treatment of prosthetic valve endocarditis. J Thorac Cardiovasc Surg. 1996;111:198–207.CrossRefGoogle Scholar
  11. 11.
    Rallidis LS, et al. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J. 1999;138:351–7.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Gordon SM, et al. Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997. Ann Thorac Surg. 2000;69:1388–92.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Sinning JM, et al. Evaluation and management of paravalvular aortic regurgitation after transcatheter aortic valve replacement. J Am Coll Cardiol. 2013;62:11–20.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    Alkhouli M, et al. Techniques and outcomes of percutaneous aortic paravalvular leak closure. JACC Cardiovasc Interv. 2016;9:2416–26.CrossRefGoogle Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    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.CrossRefGoogle Scholar
  23. 23.
    Binder RK, Webb JG. Percutaneous mitral and aortic paravalvular leak repair: indications, current application, and future directions. Curr Cardiol Rep. 2013;15:342.CrossRefGoogle Scholar
  24. 24.
    Wells JA, et al. Outcomes after paravalvular leak closure: Transcatheter versus surgical approaches. JACC Cardiovasc Interv. 2017;10:500–7.CrossRefGoogle Scholar
  25. 25.
    Smolka G, et al. Multiplug paravalvular leak closure using Amplatzer Vascular Plugs III: A prospective registry. Catheter Cardiovasc Interv. 2016;87:478–87.CrossRefGoogle Scholar
  26. 26.
    Goktekin O, et al. Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder. EuroIntervention. 2016;11:1195–200.CrossRefGoogle Scholar
  27. 27.
    Nietlispach F, et al. Transcatheter closure of paravalvular defects using a purpose-specific occluder. JACC Cardiovasc Interv. 2010;3:759–65.CrossRefGoogle Scholar
  28. 28.
    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.CrossRefGoogle Scholar
  29. 29.
    Calvert PA, et al. Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation. 2016;134:934–44.CrossRefGoogle Scholar
  30. 30.
    Taramasso M, et al. Catheter-based treatment of paravalvular leaks. EuroIntervention. 2016;12:S55–60.CrossRefGoogle Scholar
  31. 31.
    Smith CR, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.CrossRefGoogle Scholar
  32. 32.
    Luu J, et al. Percutaneous closure of paravalvular leak after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2013;6:6–8.CrossRefGoogle Scholar
  33. 33.
    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.Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Alberto Pozzoli
    • 1
    Email author
  • Maurizio Taramasso
    • 1
  • Michel Zuber
    • 1
  • Shingo Kuwata
    • 1
  • André Plass
    • 1
  • Marco Russo
    • 1
  • Fabian Nietlispach
    • 1
  • Francesco Maisano
    • 1
  1. 1.UniversitätsSpital Zürich, University of Zürich, University Heart Clinic ZürichZürichSwitzerland

Personalised recommendations