Percutaneous Transapical approach in the Treatment of Paravalvular Leak

Abstract

Background: Paravalvular leaks (PVLs) occur in up to 17% of patients after valve replacement. Due to the high morbidity and mortality associated with re-operation, percutaneous transapical (TA) closure has been introduced as an alternative to the surgical repair and percutaneous transcatheter closure in the treatment of PVLs. Here, we evaluated the outcomes of patients who underwent TA-closure for PVLs at the our centre.Methods: This study analyzed records of 12 patients with 13 problematic mechanical valves who underwent treatment at our hospital from April 2015 to November 2018. All procedures were performed under general anesthesia, with preoperative CT reconstruction and guidance by three-dimensional transesophageal echocardiography (3D-TEE). Results: Our data showed that all the TA punctures were successful with delivery sheath sizes that ranged from 5-7 Fr. Out of the 13 valves, 10 were single leaks (76.9%) and were all closed by a single occluder. There were 2 double leaks (15.3%) which were closed by two single bigger devices, while the remaining double leak was corrected by two separate devices. The median duration of the procedure was 82 minutes (IQR, 65-85 minutes). In addition, the mean postoperative ICU stay was 4 days (IQR, 1-2 days) and mean duration from procedure to hospital discharge was 7 days (IQR, 4-7 days). One patient died prior to the discharge. Conclusion: Taken together, our data demonstrates that percutaneous TA is safe and is associated with a low complication rate and procedure-related mortality. Multiple leaks and diameter of ≥ 10 mm might increase the risk for residual regurgitation.