Closure Of Aortic Paravalvular Leak Research Articles

D-44 | Mitral and Aortic Paravalvular Leak Closure in Mechanical Prothesis, Retrospective Analysis of a Single Center

D-44 | Mitral and Aortic Paravalvular Leak Closure in Mechanical Prothesis, Retrospective Analysis of a Single Center

Device Closure of Aortic Paravalvular Leak

Significant paravalvular leak is a serious complication of surgical valve replacement. Approximately 1–5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or haemolytic anaemia. Surgical intervention was the standard care of treatment for this for years. We describe a case of aortic paravalvular leak, managed with transcatheter closure. Keywords Paravalvular leak, vascular plug, trans catheter closure

Simultaneous percutaneous closure of aortic paravalvular leak and residual shunt of ventricular septal defect.

Simultaneous percutaneous closure of aortic paravalvular leak and residual shunt of ventricular septal defect.

Iatrogenic Aortic Stenosis During a Case of Aortic Paravalvular Leak Closure

We report the case of a 70-year-old male patient with prior aortic valve replacement (AVR) using a Carpentier-Edwards PERIMOUNT Magna Ease pericardial bioprosthesis 19 mm valve for severe aortic stenosis. He presented to our institution 2 ​years later with severe hemolytic anemia requiring regular blood transfusions and pulmonary edema hospitalizations.

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

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.

Successful percutaneous closure of aortic paravalvular leak in a patient with repeated episodes of open-heart surgery

Successful percutaneous closure of aortic paravalvular leak in a patient with repeated episodes of open-heart surgery

Balloon leakage dilation over arterio-aorta rail support greatly facilitates a complex aortic paravalvular leak closure.

Balloon leakage dilation over arterio-aorta rail support greatly facilitates a complex aortic paravalvular leak closure.

Diastolic blood pressure predicts outcomes after aortic paravalvular leak closure.

We sought to determine hemodynamic effects of aortic paravalvular leak (PVL) and predictors of clinical outcomes after aortic PVL closure. The significance of hemodynamic alterations in PVL and relation to severity, procedural success of percutaneous closure and clinical outcomes have not been defined. Patients undergoing percutaneous PVL closure between July 21, 2004 and September 10, 2018 were included. PVL severity was assessed by echocardiography and aortic angiography. Hemodynamics were assessed by intra-arterial pressure tracings before and after PVL closure. The primary outcome was a composite of mortality, redo aortic valve replacement (AVR) and redo PVL closure. One hundred and seventeen patients (mean age 70.3 ± 14.9 years, 79% surgical and 21% transcatheter prostheses) underwent PVL closure with 94% technical success. PVL was moderate or greater in 106 (91%) at baseline and 11 (11%) post-procedure. Diastolic BP for those with moderate or greater PVL was lower than for those with less PVL (50.3 ± 11.7 vs. 56.5 ± 12.4 mmHg, p < .001). Pulse pressure was similar between these groups (69.9 ± 20.3 vs. 67.4 ± 21.2 mmHg, p = .39). 35 patients (34%) had 40 events during a mean follow-up of 1.6 ± 1.9 years (23 deaths, 12 redo AVR, and five redo PVL closures). In a multivariate model, final diastolic BP <47 mmHg (HR 3.27 [1.45-7.36], p = .007) was a significant predictor of the composite endpoint. Diastolic BP was significantly associated with aortic PVL severity and clinical outcomes after PVL closure. In contrast, pulse pressure did not correlate with PVL severity or outcomes. These findings have implications for clinical management of patients with aortic PVL.

Percutaneous Paravalvular Leak Closure Post Aortic Valve Surgery: The Auckland Experience

Background: Significant paravalvular aortic regurgitation (PAR) post aortic valve replacement (AVR) is associated with high morbidity and mortality in these patients particularly when necessitating re-do surgical AVR. Percutaneous closure is emerging as an alternative to surgery. Methods: We evaluated 11 patients between January 2010 and December 2016 in whom percutaneous closure of an aortic paravalvular leak was attempted in the Auckland City Hospital Catheterisation Laboratory. Results: Procedural success with adequate obliteration of the paravalvular defect was achieved in 8 (73%) patients. There was a significant reduction in PAR in these patients (figure below) with the majority retaining only trivial-mild PAR. Clinical haemolysis was resolved or significantly reduced in the 4 patients with pre-procedure haemolytic anaemia and successful procedure. In 3 cases the procedure was unsuccessful due to inability to cross the paravalvular defect channel. There was one complication with device embolisation, without clinical sequelae. Conclusion: This case series has shown that percutaneous aortic paravalvular leak closure post AVR provides acceptable procedural and clinical success with minimum risk, and should be considered as an alternative to re-do surgery.

Techniques and Outcomes ofPercutaneous Aortic ParavalvularLeakClosure.

The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p< 0.001). In patients with severe hemolysis (n=8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p= 0.004). Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore,attempts should be made to reduce PVL as much as possible.

Cierre percutáneo de fugas periprotésicas con el dispositivo Amplatzer Vascular Plug III: resultados inmediatos y a corto plazo

Introduction and objectivesPercutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. MethodsThe immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. ResultsPercutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). ConclusionsMitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates.Full English text available from:www.revespcardiol.org/en

Paravalvular Leak Closure With the Amplatzer Vascular Plug III Device: Immediate and Short-term Results

Introduction and objectivesPercutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. MethodsThe immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. ResultsPercutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). ConclusionsMitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates.

Percutaneous closure of an aortic paravalvular leak via the transradial approach

Percutaneous closure of aortic and mitral paraprosthetic leaks using the Amplatzer occluders (muscular ventricular septal defect occluder) is now a well recognized procedure although as "off label" use. Aortic paravalvular leak closure is usually carried out via transfemoral puncture, but problems with this approach include the need to stop warfarin and the inadequate length of standard delivery sheaths. We report the first case of percutaneous aortic paravalvular leak closure through the radial artery route.