Percutaneous closure of paravalvular leak after surgical prosthetic valve implantation: Single-centre experience
█ Original article
Nagy Zsolt1, Fontos Géza1, Ablonczy László2, Szatmári András2, Szegedi Margit1, Temesvári András1, Andréka Péter1
Gottsegen György Országos Kardiológiai Intézet,
1Felnőtt Kardiológiai Osztály,
2Gyermekszív Központ, Budapest
Introduction: Paravalvular leaks occur in 5-10% of cases after surgical valve implantation based on literature reviews. Majority of paravalvular leaks are harmless, however rarely they cause heart failure or severe hemolytic anemia requiring repeated transfusion. In high risk patients transcatheter leak closure may represent an alternative to surgery.
Methods: 28 patients (15 male, 13 female) were examined, who underwent percutaneous paravalvular leak closure between 2010–2018. Clinical and echocardiography parameters, procedural success rate, early and late procedural complications, and survival were retrospectively analyzed.
Results: Patient mean age was 69.56±11.29 year. Indications for closure were heart failure (20 patients), transfusion requiring hemolytic anemia (4 patients), both heart failure and transfusion requiring hemolytic anemia (3 patients), furthermore in 1 special case an aorta conduit endoleak. Percutan leak closure was successful in 82% of patients (23 patients). After successful percutaneous closure TEE showed significant reduction of paravalvular regurgitation. NYHA functional status improved in 76% of patients after 15 months (9–103 months) median follow-up. After percutaneos closure 1 year survival rate was 77% and 1 patient with worsening hemolytic anemia underwent surgical repair.
Conclusion: Percutaneous paravalvular leak closure is safe and feasible in high risk patients and effectively improves clinical state. Percutaneous closure may be an alternative to surgery in high risk patients.