Mitral Paravalvular Leak Closure: The Apical Approach

Abstract

Prosthetic paravalvular leaks (PVLs) are well-recognized complications of surgical and transcatheter valve replacement. Various series have demonstrated that 5–15% of all surgical valve replacements are complicated by some form of PVL and, specifically, 40–70% of patients who undergo transcatheter aortic valve replacement. Significant PVL could lead to major clinical and hemodynamic consequences and impacts long-term survival.Reoperation for PVL is associated with a high recurrence rate and carries with it significant morbidity and mortality risks. Alternatively, efforts have been made to seal PVL percutaneously by delivering occluders at the site of leak, preventing or reducing the amount of regurgitation. Percutaneous approach is now an established therapy for symptomatic patients with PVL and is frequently considered as primary therapy for eligible patients. To deliver these devices, multiple approaches have been used, including retrograde transaortic, anterograde transseptal and more recently transapical (TA). This chapter reviews the utility and technique of transcatheter mitral paravalvular leak closure using surgical and percutaneous transapical approaches.