Percutaneous Paravalvular Leak Closure

Krishnaswamy, Amar; Kapadia, Samir; Tuzcu, E. Murat

doi:10.1253/circj.cj-12-1433

Cited by 40 publications

(9 citation statements)

References 23 publications

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“…Percutaneous closure of mitral PVLs is not yet a completely standardized technique . Antegrade transeptal approach is preferred, but retrograde transaortic and retrograde transapical approaches may also be used .…”

Section: Discussionmentioning

confidence: 99%

“…In patients at high‐risk for surgical reintervention, percutaneous closure of paravalvular leaks (PVL) has gained increasing acceptance among interventional cardiologists. If needed (especially for large crescent defects), implantation of multiple occluders may be performed, by simultaneous or sequential technique . We describe the case of a large anteroseptal bioprosthetic mitral PVL causing massive regurgitation that was successfully treated by antegrade transeptal, single‐stage, percutaneous approach, under real‐time three‐dimensional transesophageal echocardiographic (3D‐TEE) guidance, using the modification of a previously described anchoring‐based technique for sequential implantation of multiple devices .…”

Section: Introductionmentioning

confidence: 99%

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Mitral paravalvular leak closure by antegrade percutaneous approach: Three‐dimensional transesophageal echocardiographic guided multiple amplatzer implantation by a modified sequential anchoring‐based technique

Tarantini

Mojoli

Napodano

2013

Cathet Cardio Intervent

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We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, which was manaed by antegrade transseptal, single-stage, percutaneous approach. Real-time three-dimensional transesophageal echocardiographic guidance was crucial to ensure successful recrossings of the target defect and the optimal anatomical closure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mitral paravalvular leak closure by antegrade percutaneous approach: Three‐dimensional transesophageal echocardiographic guided multiple amplatzer implantation by a modified sequential anchoring‐based technique

Tarantini

Mojoli

Napodano

2013

Cathet Cardio Intervent

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“…The leaks may be hemodynamically significant or can be associated with significant hemolysis. Moderate regurgitation results in worse patient outcomes [21]. No device is currently approved in the USA and catheter-based interventions are performed off-label.…”

Section: Paravalvular Leaksmentioning

confidence: 99%

New devices and technology in interventional cardiology

Tobis¹,

Abudayyeh²

2015

Journal of Cardiology

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There have been substantial improvements made in the tools and techniques used since the advent of percutaneous coronary intervention. What was primarily developed as a treatment of coronary artery disease is now used to address a variety of structural heart disease problems. The outcomes have been remarkably successful with relatively low complication rates that rival the results of open-heart surgery. This article will review some of the new devices available for management of structural cardiac conditions including congenital defects and acquired valvular abnormalities. Transcatheter treatment offers advantages over surgical intervention in recovery time, improved patient satisfaction, lower procedural risk, and avoidance of cardio-pulmonary bypass especially in high-risk patients. We will discuss different medical conditions and introduce the devices used to treat these conditions. Each device or technique has benefits and risks, and familiarity with the devices along with patient selection will best optimize the outcome.

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“…Paravalvular leak (PVL) is an uncommon but serious complication of mechanical or bioprosthetic surgical valve replacement (e.g. mitral valve replacement – MVR) and may be seen in 2–12% of patients after MVR [ 1 ]. Most PVLs are clinically silent, but 1–5% of patients become symptomatic because of heart failure, haemolysis or both and require re-operation [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In many registries and metaanalyses, the safety and efficacy of PVL closure has been reported, with a reasonable rate of procedural success and a low rate of major complications [ 5 – 7 ]. Because there are no specific devices for PVL closure and because of the heterogeneity in the size and shape of the defects, variable vascular and septal occluder devices can be used by the operators [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Closure of mitral paravalvular defects without performing an arteriovenous loop: a case series of fourteen patients

Kılıçgedik

Gündüz

Fedakar

et al. 2017

pwki

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IntroductionThe arteriovenous (AV) loop is recommended when further support is needed during paravalvular leak (PVL) closure.AimWe report the feasibility and safety of mitral PVL closure without constructing an AV loop, based on a single-centre experience.Material and methodsFourteen patients with mitral valve replacement (MVR) who had New York Heart Association (NYHA) class III–IV dyspnoea or NYHA class II symptoms with significant haemolytic anaemia caused by severe or moderate-to-severe paravalvular regurgitation and who underwent transcatheter PVL closure (TPVLC) between May 2014 and February 2017 were enrolled.ResultsIn total, 15 PVL procedures and 19 device deployments were performed. The patients had one (n = 10), three (n = 1) or four (n = 1) devices for closure at the time of the procedure; one patient had two devices from two procedures at different times with different access ways. Nineteen devices (10 (66.6%) via transseptal access; 4 (26.6%), transapical access; and 1 (6.6%), retrograde access) were deployed successfully without making an AV loop.ConclusionsThe TPVLC is a less invasive and effective alternative to surgery in symptomatic patients with significant PVLs and high operational risks. The success rates are satisfactory, with improving techniques and devices. Procedural success without using an AV loop can be achieved with reduced costs, fluoroscopic times and complications.

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Percutaneous Paravalvular Leak Closure

Cited by 40 publications

References 23 publications

Mitral paravalvular leak closure by antegrade percutaneous approach: Three‐dimensional transesophageal echocardiographic guided multiple amplatzer implantation by a modified sequential anchoring‐based technique

Mitral paravalvular leak closure by antegrade percutaneous approach: Three‐dimensional transesophageal echocardiographic guided multiple amplatzer implantation by a modified sequential anchoring‐based technique

New devices and technology in interventional cardiology

Closure of mitral paravalvular defects without performing an arteriovenous loop: a case series of fourteen patients

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