TRANSCATHETER REDUCTION OF PARAVALVULAR LEAKS ON PROSTHETIC VALVES: SHORT AND LONG-TERM OUTCOMES

Abstract

Severe paravalvular leaks (PVL) cause refractory congestive heart failure (CHF), hemolysis, and are associated with high mortality rates. Surgical correction is currently the gold standard therapy, but is rarely considered in patients with significant comorbid conditions. In such cases, the transcatheter reduction of PVL (TRPVL) is emerging as an alternative therapeutic option. The present study sought to describe the procedural details and long-term outcome of TRPVL in patients unsuitable for surgical reduction. Eighty consecutive patients who underwent TRPVL at the Montréal Heart Institute from June 2001 to December 2014 were analyzed over 225 patient-years of follow-up data. Procedural success was defined as leak reduction ≤ 2+ assessed by echocardiography. Patients (50% males) were aged 66 ± 9.7 years, with an average of 2.2 prior surgeries and a mean logistic Euroscore-2 of 6.4% ± 3.8%. Mitral TRPVLs were performed in 80% (n=64) of cases. In-hospital mortality was 2.5%. Procedural success was obtained in 66% (n=53) of patients. In those patients, survival free of death was 85%, 71% and 56% at 1, 3, and 5 years, respectively; significantly better compared to patients after failed procedures (76%, 55% and 19%; p<0.05). Procedural success was also associated with significant improvement in survival free of re-hospitalization for CHF at 1 year, 88% vs 59% (p<0.05). In patients deemed ineligible for surgical PVL correction successful TRPVL is associated with improved survival and reduced re-hospitalization for heart failure.