Comparison of trans-catheter closure of paravalvular leak versus surgical approach-outcomes and cost analysis

Abstract

Abstract Background The outcomes and costs of trans-catheter closure (TC) of paravalvular leak (PVL) compared with surgical closure (SC) are rarely described. Purpose The aim of the study was to assess the outcomes and hospital costs of patients who underwent TC or SC of PVL in our center. Methods Patients who underwent TC and SC of PVL between Jan. 2016 and Dec. 2019 were enrolled. Baseline characteristics, procedural, in-hospital and mid-term outcomes and hospital costs were compared. Results A total of 141 patients were studied (TC, n=65 and SC, n=76). The patients were elder in TC group (56.8±12.8 years vs. 50.1±12.8 years, p=0.002). Technical success was higher in SC group (83.1% vs. 98.7%, p<0.001). Procedure room time (93±38 min vs. 395±132 min, p<0.001), intensive care unit time (0 h vs. 25 h, p<0.001), length of stay from hospitalization to discharge (7 days vs. 21 days, p<0.001) and costs (¥45090±19343 vs. ¥164165±94300, p<0.001) were significantly less in TC group. After risk adjustment, there was no significant differences between in 30 days survival between TC group and SC group. However, the residual PVLs were less in SC group (43.1% vs. 12.0%, p=0.012). At a median follow-up of 21 months, there was a trend towards reduce all-cause death following TC versus SC (OR=0.054, 95% CI: 0.070 to 0.445, p=0.007). Conclusions SC for PVL is associated with higher technical rates and less residual shunt. But, the shorter length of stay and lower resources use with TC group significantly reduce hospital costs. In addition, TC achieve a better mid-term results in survival. Funding Acknowledgement Type of funding source: None