Transcatheter and Surgical Management of Mitral Paravalvular Leak

Alkhouli, Mohamad; Rihal, Charanjit S.; Zack, Chad J.; Eleid, Mackram F.; Maor, Elad; Sarraf, Mohammad; Cabalka, Allison K.; Reeder, Guy S.; Hagler, Donald J.; Maalouf, Joseph F.; Nkomo, Vuyisile T.; Schaff, Hartzell V.; Said, Sameh M.

doi:10.1016/j.jcin.2017.07.046

Cited by 89 publications

(71 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, CPHA commonly presents with ambiguous symptoms, and insidious onset posing highlighting the need for a high index of suspicion. In a study of 381 patients who were referred for treatment of mitral PVL (of whom 40% had hemolysis), the mean time from index valve replacement to referral was 85.1 ± 115.6 months . Hence, in patients with cardiac prostheses who have unexplained anemia, a systematic step‐wise approach to exclude/diagnose CPHA is warranted (Figure ):…”

Section: Clinical Presentation and Diagnostic Approachesmentioning

confidence: 99%

“…Timing of presentation: Severe anemia after LVAD insertion or valve replacement should raise suspicion of a causal relationship between the cardiac prosthesis and hemolysis in the absence of bleeding or infection. Nonetheless, CPHA can often be insidious and may not be detected clinically until later stages …”

Section: Clinical Presentation and Diagnostic Approachesmentioning

confidence: 99%

“…Nonetheless, this can be challenging due to various patients' and device‐specific reasons. Indeed, up to 30% of patients undergoing percutaneous PVL repair have >mild residual PVL following intervention even at centers of excellent . Among patients with significant residual leaks, a small percentage will experience worsening of hemolysis often requiring percutaneous or surgical device retrieval .…”

Section: Management Of Cardiac Prosthesis‐related Hemolysismentioning

confidence: 99%

See 2 more Smart Citations

Cardiac prostheses‐related hemolytic anemia

Alkhouli

Farooq

et al. 2019

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Clinical Presentation and Diagnostic Approachesmentioning

confidence: 99%

Section: Clinical Presentation and Diagnostic Approachesmentioning

confidence: 99%

Section: Management Of Cardiac Prosthesis‐related Hemolysismentioning

confidence: 99%

See 1 more Smart Citation

Cardiac prostheses‐related hemolytic anemia

Alkhouli

Farooq

et al. 2019

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…PVL is associated with significant morbidity and mortality after surgical valve replacement . Successful surgical or percutaneous closure of mitral PVL reducing mitral regurgitation severity to mild or less is associated with significant improvement in survival and NYHA class heart failure compared with greater severity of residual regurgitation . Moderate to severe residual PVL at end of MTVR procedure (including post‐dilatation or PVL closure attempt in some) was reported in 4.9% of patients in the TMVR in MAC Global registry .…”

Section: Discussion and Lessons Learnedmentioning

confidence: 99%

Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

Al‐Hijji

Sabbagh

Guerrero

et al. 2019

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Background Treatment of hemodynamically significant mitral annular calcification (MAC) using transcatheter approaches is in the early learning phase. The occurrence of paravalvular leak (PVL) following transcatheter mitral valve in MAC is common. Aims To report the initial experience and techniques of percutaneous PVL closure after transcatheter valve in MAC. Methods This series includes five consecutive patients who underwent percutaneous PVL closure following transcatheter balloon expandable SAPIEN S3 valve in MAC. Results Mean patient age was 73.6 ± 5.4 years (4 [80%] female), with average Society of Thoracic Surgeons score of 8.1 ± 2.8%. Three patients had a single PVL defect while two patients had two defects; all were located at the commissural sites. Closure was performed primarily for heart failure in four patients and hemolytic anemia in one patient. Transfemoral transseptal antegrade approach and Amplatz Vascular Plug (AVP)‐II occluders were utilized in all patients. Procedure success was achieved in three patients. One patient developed significant occluder related leaflet impingement and subsequent severe prosthetic mitral regurgitation requiring a second transcatheter mitral valve in valve implantation. The procedure was aborted in one patient due to difficulty crossing PVL defect after balloon post‐dilatation of SAPIEN prosthesis with 10 mL of additional volume. There was no in hospital or 30 day mortality or the need for emergent surgery. Conclusion Early experience with percutaneous PVL closure of SAPIEN valve in MAC demonstrated feasibility of this approach. Careful procedure planning and monitoring for SAPIEN prosthesis leaflet impingement and frame instability is of utmost importance to increase the chances of procedural success.

show abstract

“…Recent studies have demonstrated that successful PVL closure defined as mild or less residual regurgitation is associated with improved survival 8. Long-term survival appears to be similar after surgical and transcatheter mitral PVL closure, with a trend towards higher rates of repeat intervention in patients undergoing surgical mitral PVL closure 17. Repeat PVL closure is most commonly required due to the development of new defects and has a similar success rate compared with first time procedures 18.…”

Section: Outcomes and Future Directionsmentioning

confidence: 99%