Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement.

Hui Zhang,Zhong-Ying Xu,Jian-Hua Lv,Kun-Jing Pang,Ge-Jun Zhang,Xiang-Bin Pan,Hai-Bo Hu,Liang Xu,Rui-Gang Xie,Jing-Yan Wang,Qi Jin

doi:10.3389/fcvm.2021.589947

Abstract

Background: Transcatheter closure of paravalvular leak (PVL) has evolved into an alternative to surgery in high-risk patients. In this study, we introduce a new access for transcatheter closure of PVL and seek to evaluate the feasibility and safety of this access.Methods: We retrospectively analyzed patients undergoing transbrachial access for transcatheter mitral or aortic PVL closure (August 2017–November 2019) at our hospital. All patients underwent puncture of the brachial artery under local anesthesia.Results: The study population included 11 patients, with an average age of 55.91 ± 14.82 years. Ten out of 11 patients were successfully implanted with devices via the brachial artery approach, and one patient was converted to the transseptal approach. The technical success rate of transbrachial access was 90.9%. Mean NYHA functional class improved from 3.1 ± 0.5 before the procedure to 1.9 ± 0.5 after PVL closure. Severe paravalvular regurgitation (PVR) in five patients and moderate PVR in six patients prior to the procedure were significantly reduced to mild in four patients and none in seven patients after the procedure. Complications included one case of pseudoaneurysm and one case of moderate hemolysis aggravation after closure. One patient had an unknown cause of sudden death within 24 h after the procedure. The half-year mortality rate during follow-up was 9.1% (1/11).Conclusions: Transbrachial access for transcatheter closure of PVL may be a feasible and safe treatment and should include well-selected patients. It has several potential advantages of simplifying the procedure process and reducing postprocedural bed rest time.

Highlights

Paravalvular leak (PVL) is a common and challenging complication following prosthetic valve replacement
2–5% of PVLs are associated with congestive heart failure (HF), hemolytic anemia, and infective endocarditis and need further surgical or interventional treatment [1, 2]
The three traditional routes all need to stop warfarin before the procedure and need bed rest and activity restriction after the procedure. Another potential problem is that the working distance of the standard sheath is too short to reach the level of the mitral valve in taller patients via the transfemoral or transseptal approach

Summary

Introduction

Paravalvular leak (PVL) is a common and challenging complication following prosthetic valve replacement. Since transcatheter closure of PVL was first reported in 1992 [3], it has been developed into a feasible alternative to repeat surgery in recent years [4, 5]. The three traditional routes all need to stop warfarin before the procedure and need bed rest and activity restriction after the procedure. Another potential problem is that the working distance of the standard sheath is too short to reach the level of the mitral valve in taller patients via the transfemoral or transseptal approach. Transcatheter closure of paravalvular leak (PVL) has evolved into an alternative to surgery in high-risk patients. We introduce a new access for transcatheter closure of PVL and seek to evaluate the feasibility and safety of this access

Objectives

Methods

Results

Conclusion