Interventions for valvular disease and heart failure

Long-term outcomes of catheter-based intervention for clinically significant paravalvular leak

EuroIntervention 2021;17:736-743. DOI: 10.4244/EIJ-D-20-01206

Leor Perl
Leor Perl1, MD; Amir Cohen1, MD; Alexander Dadashev1, MD; Yaron Shapira1, MD; Hana Vaknin-Assa1, MD; Vered Yahalom2, MD; Alexander Sagie1, MD; Ran Kornowski1, MD; Rafael Hirsch1, MD
1. Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel; 2. Blood Services & Apheresis Institute, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel

Background: In most centres, clinically significant percutaneous paravalvular leak (PVL) closure following valve replacement surgery is reserved for those considered high-risk for surgery. There is a paucity of data regarding the long-term outcomes of these patients.

Aims: Our goals were to assess the long-term outcomes of patients undergoing percutaneous PVL closure.

Methods: A total of 100 consecutive transcatheter PVL closure procedures (74 mitral, 26 aortic) were performed in 95 patients between February 2005 and August 2019 at our hospital. Data collected included procedural success rates, indication-specific outcomes and mortality.

Results: Mean follow-up was 5.6±6.1 years, mean age 62.6±15.2 years, and 45.4% were female. The device was successfully implanted in 88 procedures (88.0%). Patients who presented with heart failure (n=57) had a significant improvement in NYHA classification (29.2% Class III/IV versus 100.0%, p<0.001). For patients who presented with haemolytic anaemia (n=38), haemoglobin increased (11.94±1.634 vs 9.72±1.49, p<0.001) and LDH levels were reduced (1,354.90±1,225.55 vs 2,039.40±1,347.20, p<0.001) following the procedure. Rates of mortality were 3.8% at 90 days, 15.6% after 1 year, and 27.2% after 5 years.

Conclusions: For patients who are deemed intermediate- to high-risk for repeat surgery, transcatheter PVL closure shows reasonable clinical success rates, with a significant improvement in symptoms, and a relatively low rate of periprocedural complications.

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degenerative valvemiscellaneousparavalvular leakprior cardiovascular surgeryspecific closure device/technique
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