Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience

Abstract

A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

“…[143][144][145]160 In general, patients with mechanical valve replacement experience a higher risk of bleeding due to anticoagulation, whereas individuals who receive a bioprosthetic valve replacement experience a higher rate of reoperation due to structural deterioration of the prosthesis and perhaps a decrease in survival. 142,143,[145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160]162 Stroke rate appears to be similar in patients undergoing either mechanical or bioprosthetic AVR, but it is higher with mechanical than with bioprosthetic MVR. [142][143][144][145]157 There are several other factors to consider in the choice of type of valve prosthesis (Table 3).…”

“…Ultimately, the choice of mechanical versus bioprosthetic valve replacement for all patients, but especially for those between 50 and 70 years of age, is a shared decision-making process that must account for the trade-offs between durability (and the need for reintervention), bleeding, and thromboembolism. 143,[145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160]162 IIa B A bioprosthesis is reasonable for patients more than 70 years of age. [163][164][165][166] 2014 recommendation remains current.…”

Percutaneous paravalvular leak closure: chasing the chameleon

“…Perioperative complications are less frequently observed in percutaneously treated patients (infection, stroke, and myocardial infarction; 6.5% vs. 0%). 12 For procedural orientation, aortic leaks should be described according to the proximity of the respective cusp (right, left, and noncoronary cusp), whereas the mitral leaks are typically described on a clock-scale from 1 to 12 o'clock, with 12 o'clock facing anterior (to the aortic valve) and 3 o'clock facing towards the atrial septum, as seen on a typical 3D TEE left atrial 'surgeons view'. An alternative to the clock-face approach is the simple 'anatomic approach', which is less dependent on cardiac rotation: with this method a mitral leak is described to be (i) anterior or posterior and (ii) medial or lateral, or (iii) a combination thereof (e.g.…”

Transapical Paravalvular Leak Closure: A Case Report

“…In the case presented, presence of aortic valve prothesis and anteromedial position of PVL led us to choose TA access. TA access can be provided by direct puncture or open surgical LV apical access via left anterolateral mini thoracotomy [8,9]. There is no direct comparison of open surgical and percutaneous TA access to date, so the decision is mainly dependent on experience of the operator.…”

“…TA approach for percutaneous mitral PVL closure is associated with favorable outcomes and acceptable morbidity in patients with high surgical risk [8,9]. It also decreases procedure and fluoroscopy times, provides opportunity to directly cross mitral PVL defects.…”