Transcatheter Closure of Mitral Paravalvular Leak via Multiple Approaches.

Yang Liu,Min Chen,Jiayou Tang,Jian Yang,Peng Ding,Hongliang Zhao,Ping Jin,Lanlan Li,Chennian Xu,Xin Meng,Ziyad M Hijazi

doi:10.1155/2021/6630774

Abstract

Objectives The purpose of this study was to review the experiences with transcatheter closure of mitral PVL after surgical valve replacement. Background Transcatheter closure of paravalvular leak (PVL) is an intricate alternative to surgical closure. But it represents one of the most intricate procedures in the field of structural heart interventions, especially for patients with mitral PVL. Methods From January 2015 through January 2019, 35 patients with mitral PVL after valve replacement underwent transcatheter closure. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up was 26 (3–48) months. Results Acute procedural success was achieved in 33/35 (94.3%) patients. Twenty-five patients had single mitral prosthetic valve replacements; 10 had combined aortic and mitral prosthetic valve replacements previously; 28 had mechanical valves; and 7 had bioprosthetic valves. All percutaneous procedures were performed with local anesthesia except for seven transapical cases with general anesthesia. Multiple approaches were used: transfemoral, transapical, and transseptal via an arteriovenous loop. Multiple devices were deployed. There were no hospital deaths. The procedural time was 67–300 (124 ± 62) minutes. Fluoroscopic time was 17–50 (23.6 ± 12.1) minutes. The hospital stay was 5–17 (8.3 ± 3.2) days. Complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. Twenty-seven (77.1%) patients improved by ≥1 New York Heart Association functional class at the 1-year follow-up. Conclusions Transcatheter mitral PVL closure requires complex catheter techniques. However, this minimally invasive treatment could provide reliable outcomes and shorter hospital stays in selected patients. This trial is registered with NCT02917980.

Highlights

Paravalvular leak (PVL) is a common complication after surgical valve replacement, with an incidence of 0.5%–7% in the aortic and 5%–10% in the mitral position [1,2,3,4]
Transcatheter closure of PVL has emerged as an alternative treatment for patients with a high surgical risk [9,10,11,12]
Complex catheter techniques are needed for mitral PVL closure because the physicians must cross the PVL defect and deliver the occluder, which is difficult in most cases. erefore, the reported success rate of mitral PVL closure remains from 62% to 86% in published series [13,14,15,16]

Summary

Introduction

Paravalvular leak (PVL) is a common complication after surgical valve replacement, with an incidence of 0.5%–7% in the aortic and 5%–10% in the mitral position [1,2,3,4]. Among patients with PVL, approximately 3% require treatment because of congestive heart failure or hemolytic anemia [5,6,7,8]. Transcatheter closure of PVL has emerged as an alternative treatment for patients with a high surgical risk [9,10,11,12]. Transcatheter closure of PVL is one of the most challenging structural heart disease interventions, depending largely on the location and size of the defect, especially for patients with mitral PVL. Complex catheter techniques are needed for mitral PVL closure because the physicians must cross the PVL defect and deliver the occluder, which is difficult in most cases. erefore, the reported success rate of mitral PVL closure remains from 62% to 86% in published series [13,14,15,16]

Methods

Results

Conclusion