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)
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.
#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
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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
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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
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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
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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,
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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...
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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
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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
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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...
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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...
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: 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.
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#1Ian C. Gilchrist (Penn State Milton S. Hershey Medical Center)H-Index: 32
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