Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure.

Published on Dec 12, 2016in Jacc-cardiovascular Interventions8.432
· DOI :10.1016/J.JCIN.2016.08.038
Mohamad Alkhouli24
Estimated H-index: 24
(Mayo Clinic),
Mohammad Sarraf7
Estimated H-index: 7
(Mayo Clinic)
+ 7 AuthorsCharanjit S. Rihal96
Estimated H-index: 96
(Mayo Clinic)
Sources
Abstract
Abstract Objectives 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. Background 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. Methods 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. Results 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  Conclusions 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.
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