Trans-catheter paravalvular leak closure: a single-centre experience

Tanner, Richard; Hassan, Saber; Ryan, Nicola; Murphy, Niamh; Campbell, Patricia; Margey, Ronan; Walsh, Kevin; Byrne, Roger; Blake, Gavin J.; Casserly, Ivan P.

doi:10.1007/s11845-018-1895-x

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…The average time applied in the cohort was close to two hours, which correlates well with the work by previous authors. [ 10 15 ] A number of techniques were utilized in the cohort, including rail road, buddy wire or sequential delivery of multiple occluders, and have become our preferred approach in recent times. Interposing a hydrophilic wire across the PVL while releasing the occluder prevented the need for recrossing the defect in patients requiring multiple devices reducing the procedural time significantly.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous paravalvular leak closure with their outcomes

Garg

Azad

Radhakrishnan

2021

Annals of Cardiac Anaesthesia

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Background: Transcatheter paravalvular leak (PVL) closure in recent times has emerged as a safe and effective alternate to redo-surgical repair. We sought to examine the clinical efficacy and safety of percutaneous PVL closure at our center. Methods and Results: A retrospective study from August 2012 to December 2019 of 19 patients who underwent 21 procedures for PVL closure. The mean age was 49.25 ± 14.72 years. The target valve was mitral in 11 (57%) and aortic in 7 (36%) cases. One (5%) patient had prosthetic valve in left atrioventricular valve with congenitally corrected transposition of great arteries. Majority of the cohort presented with heart failure without hemolysis (89%), with most of them being in NYHA functional class III (57%) or class IV (21%). A procedural success of 85% was achieved. Post procedure severity of regurgitation reduced from severe in thirteen patients and moderate in six patients to moderate in two patients and mild in fourteen patients. Symptomatic improvement was observed in all cases who had successful closure with NYHA function class improving from 3 ± 0.64 to 1.6 ± 0.94. The mean follow-up duration was 21 ± 13 months (median 24 months). There was one (4.7%) mortality with cumulative survival from all-cause mortality of 95%. Conclusion: The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.

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Section: Discussionmentioning

confidence: 99%

Percutaneous paravalvular leak closure with their outcomes

Garg

Azad

Radhakrishnan

2021

Annals of Cardiac Anaesthesia

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“…Open surgical redo valve surgery for patients with asymptomatic bioprosthetic aortic regurgitation and acceptable surgical risk is a Class IIa recommendation 12 . However, many patients with PVR are symptomatic on presentation or are higher risk surgical candidates which make redo sternotomy and open valve replacement less appealing 13‐15 ; furthermore, many patients do not want to undergo another major operation. Recent data has shown equivalent outcomes with transcatheter procedures compared to surgery even though the transcatheter patients had more comorbidities 16‐18 .…”

Section: Discussionmentioning

confidence: 99%

“…While a number of devices have European approval, there are currently no occluder devices approved by the United States Food and Drug Administration specifically to treat PVR 19 . The majority of data surrounding these self‐expanding occluder devices are from procedures treating a focal jet of PVR and have shown a high degree of success (>85%) and minimal rates (3.8%‐10%) of procedural complications 9,10,13,14,20‐22 . Devices available include the Amplatzer vascular occluders, Amplatzer duct occluders, Amplatzer septal occluders, and Occlutech Paravalvular Leak Devices, with selection of specific device tailored to the patient (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Valve‐in‐valve transcatheter aortic valve replacement to treat multijet paravalvular regurgitation: A case series and review

Randall

Lewandowski

Choi

et al. 2020

Clinical Cardiology

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Treatment advances for severe symptomatic aortic stenosis including transcatheter and open surgical valve replacement have improved patient survival, length of stay, and speed to recovery. However, paravalvular regurgitation (PVR) is occasionally seen and when moderate or greater in severity is associated with an at least 2‐fold increase in 1 year mortality. While several treatment approaches focused on single‐jet PVR have been described in the literature, few reports describe multijet PVR. Multijet PVR can successfully be treated with a variety of catheter‐based options including valve‐in‐valve (ViV) transcatheter aortic valve replacement (TAVR). We present two patients with at least moderate PVR following aortic valve replacement who were successfully treated with ViV TAVR along with a review of literature highlighting our rationale for utilizing each management approach. Multijet PVR can be treated successfully with ViV TAVR, but additional options such as self‐expanding occluder devices and bioprosthetic valve fracture have a role as adjunctive treatments to achieve optimal results. The etiology of multijet PVR can differ between patients, this heterogeneity underscores the paucity of data to guide treatment strategies. Therefore, successful treatment of multijet PVR requires familiarity with available therapeutic options to achieve optimal results and, by extension, decrease patient mortality.

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“…74,75 For HF symptoms, there is strong evidence that correlates lower-grade residual regurgitation with enhanced clinical outcomes, 74 and therefore, good clinical improvements are well reported in these patients. [76][77][78][79] However, there is sparse and conflicting data for improved haemolysis; only 16% of patients in a UK PVL registry 32 had documented haemolysis and follow up was limited. Further, only 35 of the 362 patients from 12 studies included in a systematic review by Millan et al 80 were haemolysis patients, and the wide confidence intervals used in this study obviate meaningful interpolations.…”

Section: Heart Failure and Haemolysismentioning

confidence: 99%

Mitral valve paravalvular leaks: Comprehensive review of literature

Janmohamed

Mishra

Geragotellis

et al. 2021

Journal of Cardiac Surgery

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Background: Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms.Aims: This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs.Methods: A comprehensive literature search was performed using PubMed, EM-BASE, Cochrane database, Google Scholar and Ovid. Search terms used included "mitral valve paravalvular leak," "transthoracic echocardiography," "2D transoesophageal echocardiography," "3D transoesophageal echocardiography," "cardiac computed tomography," (CT) "cardiac magnetic resonance imaging," "intracardiac echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous closure."Results: All patients with mPVLs should undergo regular full evaluation, including patient history, physical examination, laboratory work-up, imaging, and referral, if necessary. Echocardiography is fundamental to the diagnosis, and is augmented with cardiac magnetic resonance imaging, cardiac computerized tomography and fluoroscopy for further characterization and procedural planning amongst the structural heart team. Conclusion:The prevalence of mPVL is expected to increase proportionally to the growing number of surgical and transcatheter valve replacements conducted in the ageing population. Multimodal imaging is instrumental in guiding diagnostic and therapeutic strategies when managing mPVLs. Advances in imaging and capabilities of transcather devices will prompt growing uptake of percutaneous treatment over conventional, higher-risk surgery for mPVL management.

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Trans-catheter paravalvular leak closure: a single-centre experience

Abstract: Patients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in those patients who present primarily with HF.

Cited by 8 publications

References 17 publications

Percutaneous paravalvular leak closure with their outcomes

Percutaneous paravalvular leak closure with their outcomes

Valve‐in‐valve transcatheter aortic valve replacement to treat multijet paravalvular regurgitation: A case series and review

Mitral valve paravalvular leaks: Comprehensive review of literature

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