Abstract 15817: Transcatheter Closure of Paramitral Leaks: Use of the Agilis™ Nxt Steerable Sheath to Aid Device Placement

Abstract

Introduction: Paramitral leak (PML) has been reported in 5-17% of patients after surgical prosthetic mitral valve replacements. Transcatheter closure of PML has emerged as a Class IIa alternative to surgical repair by the AHA/ACC. Reaching all areas around the mitral annulus for device delivery from a transseptal approach can be difficult. We describe our center’s experience utilizing a transseptal approach with use of a steerable sheath and real-time 3D echo to facilitate closure. Methods: Retrospective review of cases of transcatheter PML repair from 9/09 to 2/19 at Mount Sinai Medical Center. Results: 32 patients underwent 43 catheterizations for PML closure (see Table 1). Indications for PML repair were CHF in (78%) and hemolysis (22%). 25/32 were bioprosthetic valves and the rest mechanical (7/32; table). PML’s could be crossed in 41/43 attempts (95%). Location of leaks/devices demonstrated in Figure 1. The median number of devices placed at one cath was 1 (range 1-3) and the most commonly used device was the Amplatzer muscular VSD device (64/71devices; 90%). 9/32 (28%) required an additional cath to complete PML closure. At last cath, clinical PML closure was achieved in 26/32 (81%) pts attempted. 3/32 (9%) had hemolysis from residual PML after closure and required surgical mitral valve replacement. Aside from failed attempts or those requiring repeat cath, there were no serious complications. Conclusions: Use of the Agilis™ NxT Steerable Sheath allowed closure of the majority of PML encountered. Success rates were high though a large percentage required additional caths to achieve success. Serious complications were uncommon.