TCT-682 Comparison of conventional surgery and transapical transcatheter approach for paravalvular leak closure in high risk patients: results from a single high volume institution.

Abstract

Background: Paravalvular leaks (PVL)affect up to 17% of all surgically implanted prosthetic valves. Reoperation is associated with high morbidity and mortality. Transcatheter transapical (TA) closure is an emerging alternative for selected high-risk patients with PVL. The aim of this study is to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-center experience. Methods: From October 2000 and June 2013, 136 patients with PVL were treated in our Institution: 122 patients (89.7%%) underwent surgery (68% mitral-PVL; 32% aortic-PVL) and 14 patients (10.3%) underwent TA closure (all the pts had mitral PVL; 1 case had combined mitral and aortic PVLs). All the TA procedures were performed under general anesthesia in a hybrid operative room: in all but 1 case an Amplatzer Vascular Plug III device was utilized. Results: Baseline features of the patients were comparable in terms of age (p1⁄40.9), associated coronary artery disease (p1⁄40.6), chronic renal failure (p1⁄40.2), previous endocarditis (p1⁄40.08), concomitant atrial fibrillation (p1⁄40.4), while COPD was more prevalent in TA group (P1⁄40.002). Log-EuroScore was 15 11% and 19 8% in surgical and TA group respectively (p1⁄40.03). Most of the patients were in NYHA class III-IV (60% Vs 78%; p1⁄40.1); 41% of surgical patients and 86% of TA patients were at their second of more reoperation (p1⁄40.0001). Procedural success in TA group was 93% (1 conversion to surgery because of the dislocation of the device). Inhospital mortality was 10.6% in surgical group (all cardiac-related) and 0% in TA group (p1⁄40.08). Mean LOS was 19 days for surgery and 9 days for TA (p1⁄40.1). All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as risk factor for in-hospital death at multivariate analysis (OR 1.6; p1⁄40.04). Conclusions: Transcatheter TA approach is a safe and effective therapeutic option in selected high-risk patients with PVL and it is associated with reduced risk of hospital mortality than surgical treatment, in spite of higher predicted risk. Further studies are needed to determine the long-term results of the two procedures.