Effect of percutaneous paravalvular leak closure on hemolysis

Published on Mar 1, 2019in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.27917
Sidakpal S. Panaich21
Estimated H-index: 21
(Mayo Clinic),
Elad Maor21
Estimated H-index: 21
(Mayo Clinic)
+ 6 AuthorsMackram F. Eleid33
Estimated H-index: 33
(Mayo Clinic)
Sources
Abstract
OBJECTIVE: To study the effect of percutaneous paravalvular leak closure on hemolysis. BACKGROUND: Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with paravalvular leaks (PVL), little is known about its effect on hemolysis. METHODS: We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis. RESULTS: Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044). CONCLUSION: Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves.
References22
Newest
#1Carlos E. Ruiz (Hackensack University Medical Center)H-Index: 9
#1Carlos E. Ruiz (Hackensack University Medical Center)H-Index: 33
Last. Martin B. Leon (CUMC: Columbia University Medical Center)H-Index: 182
view all 31 authors...
Abstract The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint de...
50 CitationsSource
#1Mohamad Alkhouli (Mayo Clinic)H-Index: 24
#2Mohammad Sarraf (Mayo Clinic)H-Index: 7
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 10 authors...
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 20...
33 CitationsSource
#1Patrick A. Calvert (University of Birmingham)H-Index: 19
#2David NorthridgeH-Index: 3
Last. David Hildick-Smith (Brighton and Sussex University Hospitals NHS Trust)H-Index: 66
view all 33 authors...
Background —Paravalvular leak (PVL) occurs in 5-17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. Methods —All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data was analyzed for association with death and major adverse cardiovascular events (MACE) at follow up. Results —308 PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age w...
53 CitationsSource
#1Xavier Millán (MHI: Montreal Heart Institute)H-Index: 8
#2Sabah Skaf (MHI: Montreal Heart Institute)H-Index: 2
Last. E. Marc Jolicœur (MHI: Montreal Heart Institute)H-Index: 7
view all 15 authors...
Abstract Background Significant paravalvular leak (PVL) after surgical valve replacement can result in intractable congestive heart failure and hemolytic anemia. Because repeat surgery is performed in only few patients, transcatheter reduction of PVL is emerging as an alternative option, but its safety and efficacy remain uncertain. In this study we sought to assess whether a successful transcatheter PVL reduction is associated with an improvement in clinical outcomes. Methods We identified 12 c...
56 CitationsSource
#1Rick A. NishimuraH-Index: 128
#2Catherine M OttoH-Index: 85
Last. James D. Thomas (American Society of Echocardiography)H-Index: 87
view all 12 authors...
Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,
1,705 CitationsSource
#1Paul Sorajja (Mayo Clinic)H-Index: 39
#2Allison K. Cabalka (Mayo Clinic)H-Index: 30
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
Objectives This study sought to assess the learning curve for percutaneous repair of paravalvular prosthetic regurgitation. Background Percutaneous repair of prosthetic paravalvular regurgitation is a complex procedure. There is a paucity of data on the professional experience and tools needed to achieve optimal clinical outcomes. Methods We examined the chronological experience of 200 patients (age 66 ± 13 years; 57% men) who underwent percutaneous closure of paravalvular prosthetic regurgitati...
47 CitationsSource
#1Jae Woong ChoiH-Index: 7
#2Ho Young HwangH-Index: 20
Last. Hyuk Ahn (SNU: Seoul National University)H-Index: 25
view all 5 authors...
BACKGROUND AND AIM OF THE STUDY: Paravalvular leak (PVL) is a common clinical manifestation after cardiac valve replacement. The results of surgical management for mitral PVL were evaluated and compared according to the surgery employed. METHODS: Between September 1995 and September 2009, a total of 52 patients (30 males, 22 females; mean age 57.2 +/- 13.0 years) underwent surgery for mitral PVL. Thirty-five patients (67.3%) underwent multiple cardiac surgeries more than once. PVL was treated wi...
18 Citations
#1Charanjit S. Rihal (Mayo Clinic)H-Index: 96
#2Paul Sorajja (Mayo Clinic)H-Index: 39
Last. Allison K. Cabalka (Mayo Clinic)H-Index: 30
view all 5 authors...
Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for ...
126 CitationsSource
#1Paul Sorajja (Mayo Clinic)H-Index: 39
#2Allison K. Cabalka (Mayo Clinic)H-Index: 30
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
Objectives The goal of this study was to determine the long-term clinical efficacy of percutaneous repair of paravalvular prosthetic regurgitation. Background Percutaneous repair has emerged as an effective therapy for patients with paravalvular prosthetic regurgitation. Methods We retrospectively identified 126 patients who underwent catheter-based treatment of symptomatic prosthetic paravalvular regurgitation. Patients were contacted for symptoms, clinical events, and vital status. Results The...
150 CitationsSource
Objectives The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia. Background Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgica...
230 CitationsSource
Cited By7
Newest
#1Bassim El-Sabawi (Mayo Clinic)H-Index: 6
#2Mayra Guerrero (Mayo Clinic)H-Index: 24
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 6 authors...
OBJECTIVES To determine the incidence, characteristics, and outcomes of patients with hemolysis after transcatheter mitral valve replacement (TMVR). BACKGROUND Hemolysis is an increasingly recognized complication of TMVR. Clinical outcomes and optimal management for patients with hemolysis after TMVR are unclear. METHODS Patients that underwent mitral valve-in-valve (MViV), valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) at a single center were retrospectively assessed. R...
Source
Abstract Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approa...
Source
INTRODUCTION Paravalvular leak (PVL) is a common serious complication associated with prosthetic valve implantation. OBJECTIVE The aim of this study was to report our single-center experience in a retrospective review and to analyze possible predictors of success. METHODS We performed 33 percutaneous PVL closures in 26 patients (54% female, mean age 65±13 years). All mitral prostheses were studied previously with 3D transesophageal echocardiography (TEE), and aortic prostheses with 2D/3D TEE. 3D...
1 CitationsSource
#1Bassim El-Sabawi (Mayo Clinic)H-Index: 6
#2Mayra Guerrero (Mayo Clinic)H-Index: 24
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
Transcatheter mitral valve replacement (TMVR) is emerging as an alternative treatment strategy to surgery for patients with severe mitral annular calcification (MAC) who are not candidates for traditional mitral valve surgery. Paravalvular leak (PVL) is common following TMVR for severe MAC and can lead to heart failure symptoms and/or intravascular hemolysis, the latter of which usually is clinically stable. We report the case of a 67-year-old woman with symptomatic severe aortic stenosis and mi...
1 CitationsSource
#1Sercan OkutucuH-Index: 4
#2M. Mach (University of Graz)H-Index: 1
Last. Ali OtoH-Index: 58
view all 3 authors...
Abstract Paravalvular leak (PVL) is an important complication after surgical valve replacement and might lead to serious clinical results, including heart failure and/or hemolytic anemia. PVLs are the result of an incomplete seal between the sewing ring and annulus. It frequently affects surgical valves in the mitral position, occurring in 5% to 15% of valve replacements. For years, surgery has been considered the only treatment for symptomatic patients with PVLs. However, surgical re-interventi...
2 CitationsSource
#1Lawrence N. ScottenH-Index: 11
#2David J Blundon (Camosun College)
Last. Rolland SiegelH-Index: 3
view all 4 authors...
Abstract: Objectives This in vitro study compares mechanical (MHV) and bioprosthetic (BHV) heart valves for high amplitude short duration regional flow velocities (RFV) near valve closure. Background We previously tested several clinical and prototype valves and observed RFV at levels which may be related to a dimensionless thrombogenic potential (TP). Methods A total of four valves were tested in aortic and mitral sites under pulsatile circulation in a pulse duplicator. Valves included both cli...
Source
#1Mohamad Alkhouli (WVU: West Virginia University)H-Index: 24
#2Ali Farooq (WVU: West Virginia University)H-Index: 3
Last. Chalak Berzingi (WVU: West Virginia University)H-Index: 9
view all 5 authors...
: Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis-related hemolysis.
8 CitationsSource
#1Alison DuncanH-Index: 20
#2Cesare QuartoH-Index: 12
Last. Simon J. DaviesH-Index: 55
view all 6 authors...
1 CitationsSource
#1Ian C. Gilchrist (Penn State Milton S. Hershey Medical Center)H-Index: 32
: Paravalvular leak closure may have a therapeutic effect on the extent of hemolysis that some patients experience after valve surgery. Reduction of hemolysis is most likely in a patient with a mechanical valve and is not necessarily correlated with the volume of regurgitative flow or its subsequent reduction. Hemolysis associated with biological valves are less likely to respond to perivalvular leak closure suggesting that mechanisms other than net volume of regurgitation or micro-jets are pres...
3 CitationsSource