Transcatheter paravalvular leak closure and hemolysis – a prospective registry

Abstract

IntroductionParavalvular leak (PVL) related to a surgical prosthetic valve may be associated with clinically significant hemolysis. The influence of transcatheter PVL closure (TPVLC) on hemolysis remains uncertain.Material and methodsThe prospective registry included patients undergoing TPVLC due to PVL-related heart failure and/or hemolysis. Procedural data, laboratory markers of hemolysis and heart failure status were recorded at baseline, discharge and at 1- and 6-month follow-up.ResultsOf 116 patients from all those qualified for TPVLC, 79 fulfilled the inclusion/exclusion criteria. Hemolysis was significantly more frequent in patients with mitral location of PVL and with calcifications in its channel. After TPVLC prompt reduction of lactate dehydrogenase activity (617.0 (342.0–899.0) vs. 397 (310.0–480.5) IU/l, p < 0.05) and gradual resolution of anemia (hemoglobin (HGB) 11.7 (10.4–13.8) vs. 13.4 (12.9–13.8) g%, p < 0.05) over 6 months were noted. Effective closure of PVL (> 90% reduction of PVL cross-sectional area) resulted in a more prominent increase of red blood cell count and HGB than in patients with residual regurgitation. The TPVLC-related exacerbation of hemolysis was recorded in 14 patients. Its risk was aggravated by presence of significant hemolysis at baseline or residual flow either by a partially uncovered channel or across the occluder. Reduction of hemolysis after successful TPVLC was sustained in 6-month follow-up.ConclusionsRisk factors for PVL-related hemolysis were the presence of calcifications in the defect and mitral location of PVL. The TPVLC effectively reduced hemolysis if at least 90% reduction of PVL cross sectional area was achieved. The effect was sustained in 6-month follow-up. Incomplete closure of PVL may increase the magnitude of hemolysis after TPVLC, but it occurred rarely.

Cardiac prostheses‐related hemolytic anemia

“…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 . Surgical PVL correction has been shown to be a more effective method in treating severe hemolysis than percutaneous repair .…”

“…71,72 Among patients with significant residual leaks, a small percentage will experience worsening of hemolysis often requiring percutaneous or surgical device retrieval. 81 Surgical PVL correction has been shown to be a more effective method in treating severe hemolysis than percutaneous repair. 82 In one study, persistence of or worsening hemolysis was responsible for 50% of crossovers to surgery in patients initially treated with transcatheter techniques.…”

Management of severe haemolytic anaemia due to residual small mitral paravalvular leak post-percutaneous closure: a case report

“…Smolka et al . 6 analysed 116 patients with transcatheter PVL closure, he concluded that the PVL closure effectively reduced haemolysis if at least 90% reduction of PVL cross-sectional area was achieved. The effect was sustained in 6-month follow-up.…”

Retrospective analysis of single-center early and midterm results of transapical catheter‑based mitral paravalvular leak closure with a purpose-specific device

“…Our opinion does not diverge from other authors: the Waist type of the device should be chosen for oblong or crescent shape shallow defects. To prevent the occluder from bending or folding after deployment in the defect, it should not be oversized in comparison to cross sectional measurements of the defect [ 5 , 12 ]. Bending or folding of it may cause significant residual regurgitation.…”