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Joseph TA, Lane CE, Fender EA, Zack CJ, Rihal CS. Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers. Expert Rev Med Devices 2018; 15:653-663. [DOI: 10.1080/17434440.2018.1514257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timothy A. Joseph
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Colleen E. Lane
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erin A. Fender
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chad J. Zack
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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2
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Bedair R, Morgan G, Bapat V, Kapetanakis S, Goreczny S, Simpson J, Qureshi S. Early experience with the Occlutech PLD occluder for mitral paravalvar leak closure through a hybrid transapical approach. EUROINTERVENTION 2016; 12:e1420-e1427. [DOI: 10.4244/eijy15m12_07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Aydin U, Sen O, Kadirogullari E, Onan B, Yildirim A, Bakir I. Surgical Transapical Approach for Prosthetic Mitral Paravalvular Leak Closure: Early Results. Artif Organs 2016; 41:253-261. [PMID: 27862027 DOI: 10.1111/aor.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/14/2016] [Accepted: 03/23/2016] [Indexed: 12/12/2022]
Abstract
The objective is to demonstrate safety and early clinical results of surgical transapical closure of paravalvular leaks (PVLs) following mitral valve replacement in significant regurgitation. Between March 2014 and February 2015, 12 patients (mean age 52.1 ± 6.0 years, 66.6% male) with severe symptomatic mitral PVLs (n = 13) underwent surgical transapical closure procedure through left mini-thoracotomy. All patients were in NYHA functional class III-IV and median logistic EuroSCORE was 24.2 ± 6.4% (range, 13.5-34.6%). Indications were heart failure (n = 10) and symptomatic hemolysis (n = 2) due to severe mitral regurgitation (MR). Amplatzer Vascular Plug-III devices (n = 9) were used for smaller and regular defects; whereas Atrial Septal Defect closure devices (n = 4) were used for larger defects. Technical success was achieved in 10 (83.3%) patients. One (8.5%) patient with 2 + MR was treated medically. A patient with residual 4 + MR underwent re-operation. There was no procedure-related complication including mortality, device migration, embolization, or cardiac laceration. Mean procedure and fluoroscopy times were 166.4 ± 39.5 (range, 90-210) and 25.7 ± 17.3 (range, 16-64) minutes, respectively. The mean intensive care and hospital stays were 2.1 ± 1.3 and 10.3 ± 6.5 days, respectively. Clinical efficacy was achieved in 9 (75%) of 12 patients at early follow-up of 8.5 ± 2.1 months. NYHA status was class II in two patients, and no hemolytic anemia was diagnosed. Echocardiographic studies revealed a significant reduction of preoperative MR (3-4+) to less than 1+ MR after operations (P < 0.05). Surgical transapical approach to PVL closure is a safe and effective procedure following mitral valve replacement. Early results show that this procedure can be an alternative to re-operation for high-risk patients. Further studies are needed to prove its effectiveness in the long term.
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Affiliation(s)
- Unal Aydin
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Onur Sen
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Aydin Yildirim
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Egitim Arastirma Hastanesi, Turgut Ozal Bulvari, Istanbul, Turkey
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Cruz-Gonzalez I, Rama-Merchan JC, Calvert PA, Rodríguez-Collado J, Barreiro-Pérez M, Martín-Moreiras J, Diego-Nieto A, Hildick-Smith D, Sánchez PL. Percutaneous Closure of Paravalvular Leaks: A Systematic Review. J Interv Cardiol 2016; 29:382-92. [PMID: 27242018 DOI: 10.1111/joic.12295] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Paravalvular leak (PVL) is an uncommon yet serious complication associated with the implantation of mechanical or bioprosthetic surgical valves and more recently recognized with transcatheter aortic valves implantation (TAVI). A significant number of patients will present with symptoms of congestive heart failure or haemolytic anaemia due to PVL and need further surgical or percutaneous treatment. Until recently, surgery has been the only available therapy for the treatment of clinically significant PVLs despite the significant morbidity and mortality associated with re-operation. Percutaneous treatment of PVLs has emerged as a safe and less invasive alternative, with low complication rates and high technical and clinical success rates. However, it is a complex procedure, which needs to be performed by an experienced team of interventional cardiologists and echocardiographers. This review discusses the current understanding of PVLs, including the utility of imaging techniques in PVL diagnosis and treatment, and the principles, outcomes and complications of transcatheter therapy of PVLs.
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Affiliation(s)
| | | | - Patrick A Calvert
- Queen Elizabeth Hospital, University Hospitals Birmingham and Institute of Translational Medicine, University of Birmingham, United Kingdom
| | | | | | | | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
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Yildirim A, Goktekin O, Gorgulu S, Norgaz T, Akkaya E, Aydin U, Unal Aksu H, Bakir I. A New Specific Device in Transcatheter Prosthetic Paravalvular Leak Closure: A Prospective Two-Center Trial. Catheter Cardiovasc Interv 2016; 88:618-624. [DOI: 10.1002/ccd.26439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Aydin Yildirim
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Omer Goktekin
- Cardiology Department; Bezmialem University Medical Faculty; Istanbul, Turkey
| | - Sevket Gorgulu
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Tugrul Norgaz
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Emre Akkaya
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Unal Aydin
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Hale Unal Aksu
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
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Lampropoulos K, Aggeli C, Megalou A, Barbetseas J, Budts W. Diagnosis and Treatment of Left-Sided Prosthetic Paravalvular Regurgitation. Cardiology 2015; 133:27-34. [DOI: 10.1159/000439247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022]
Abstract
Paravalvular leak (PVL) is a complication related to the surgical implantation of left-sided prosthetic valves. The prevalence of paravalvular regurgitation ranges between 5 and 20%. Left-sided prosthetic paravalvular regurgitation presents with a wide constellation of signs and symptoms ranging from asymptomatic murmur to heart failure, hemolysis and cardiac cachexia. Echocardiography plays a key role in imaging the PVL and can help in guiding the closure procedure with both transesophageal and intracardiac probes. Transcatheter closure of paravalvular regurgitations is an appealing prospect.
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Ghimire G, Capps C, Alli O. Device closure of periprosthetic paravalvular regurgitation. Expert Rev Med Devices 2015; 12:559-70. [PMID: 26305839 DOI: 10.1586/17434440.2015.1075387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Periprosthetic paravalvular regurgitation is an important sequel associated with prosthetic valves whether implanted surgically or via transcatheter approach. They can remain clinically silent or manifest as clinical heart failure, intravascular hemolysis or a combination of both. Periprosthetic defects are becoming increasingly recognized as a source of morbidity and mortality in patients with prosthetic heart valves and in the last few years, the management of this condition has evolved. This review aims to address the current knowledge on the pathophysiology, imaging modalities and management of these defects. It further details the principles, methodology and outcomes of catheter-based device therapy of periprosthetic paravalvular defects.
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Affiliation(s)
- Gopal Ghimire
- a Division of Cardiology, Department of Internal Medicine University of Alabama, Birmingham, USA
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Eleid MF, Cabalka AK, Malouf JF, Sanon S, Hagler DJ, Rihal CS. Techniques and Outcomes for the Treatment of Paravalvular Leak. Circ Cardiovasc Interv 2015. [DOI: 10.1161/circinterventions.115.001945] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mackram F. Eleid
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Allison K. Cabalka
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Joseph F. Malouf
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Saurabh Sanon
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Donald J. Hagler
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Charanjit S. Rihal
- From the Divisions of Cardiovascular Diseases and Internal Medicine (M.F.E., J.F.M., S.S., C.S.R.) and Pediatric Cardiology (A.K.C., D.J.H.), Mayo Clinic College of Medicine, Rochester, MN
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9
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Transcatheter Reduction of Paravalvular Leaks: A Systematic Review and Meta-analysis. Can J Cardiol 2015; 31:260-9. [DOI: 10.1016/j.cjca.2014.12.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022] Open
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10
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Thoracic Aorta Stent Grafting through Transapical Access. Ann Vasc Surg 2015; 29:362.e5-9. [DOI: 10.1016/j.avsg.2014.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/09/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022]
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12
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Sánchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, Sevillano JH, Arroyo-Ucar E, López T, Mesa JM, López-Sendón JL. Evolución inmediata y a medio plazo de las dehiscencias paravalvulares cerradas percutáneamente. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nijenhuis VJ, Swaans MJ, Post MC, Heijmen RH, de Kroon TL, ten Berg JM. Open Transapical Approach to Transcatheter Paravalvular Leakage Closure. Circ Cardiovasc Interv 2014; 7:611-20. [DOI: 10.1161/circinterventions.113.001171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vincent J. Nijenhuis
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J. Swaans
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martijn C. Post
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H. Heijmen
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas L. de Kroon
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurrien M. ten Berg
- From the Department of Cardiology (V.J.N., M.J.S., M.C.P., J.M.t.B.) and Department of Cardiothoracic Surgery (R.H.H., T.L.d.K.), St. Antonius Hospital, Nieuwegein, The Netherlands
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15
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Cruz-Gonzalez I, Rama-Merchan JC, Arribas-Jimenez A, Rodriguez-Collado J, Martin-Moreiras J, Cascon-Bueno M, Luengo CM. Cierre percutáneo de fugas periprotésicas con el dispositivo Amplatzer Vascular Plug III: resultados inmediatos y a corto plazo. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Kliger C, Ruiz CE. Rethinking Percutaneous Paravalvular Leak Closure: Where Do We Go From Here? ACTA ACUST UNITED AC 2014; 67:593-6. [DOI: 10.1016/j.rec.2014.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022]
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Sánchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, Sevillano JH, Arroyo-Ucar E, López T, Mesa JM, López-Sendón JL. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage. ACTA ACUST UNITED AC 2014; 67:615-23. [PMID: 25037540 DOI: 10.1016/j.rec.2014.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/30/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. METHODS We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. RESULTS Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. CONCLUSIONS Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage.
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Affiliation(s)
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Luis Calvo
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Teresa López
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - José M Mesa
- Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, Spain
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Davidavicius G, Rucinskas K, Drasutiene A, Samalavicius R, Bilkis V, Zakarkaite D, Aidietis A. Hybrid approach for transcatheter paravalvular leak closure of mitral prosthesis in high-risk patients through transapical access. J Thorac Cardiovasc Surg 2014; 148:1965-9. [PMID: 24889028 DOI: 10.1016/j.jtcvs.2014.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/14/2014] [Accepted: 05/02/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To report "hybrid" procedure feasibility and the clinical success of transcatheter paravalvular leak closure through apical access. METHODS Seven patients (73.6±6.1 years; 4 men) with severe mitral prosthesis paravalvular leak were selected. All patients were at high risk for open surgery because of severe comorbidities and heart failure (New York Heart Association class III-IV). RESULTS The defect size was 25±7.8 mm in the long axis and 9.3±2 mm in the short axis. Two defects were detected in 2 patients. The transapical procedure was performed in a "hybrid" surgery room using minithoracotomy and general anesthesia. Three-dimensional transesophageal echocardiography and fluoroscopy were used for imaging. A total of 19 Amplatzer Vascular Plug III devices (St Jude Medical) were implanted in 7 patients, 2.7/patient and 1 to 3/fistula. The procedure time was 150.7±66.8 minutes. In 6 of 7 patients (85.7%), the paravalvular leak was successfully closed, resulting in no or mild residual regurgitation. One patient had moderate regurgitation despite deployment of 3 Amplatzer Vascular Plug III devices. Two patients required blood transfusion related to procedural blood loss. The patients were discharged at 15.3±6.5 days and followed up at 215.7±138.6 days. All but 1 patient reported symptomatic improvement by ≥1 New York Heart Association class at follow-up. One patient died 216 days postoperatively. CONCLUSIONS A "hybrid approach" for transcatheter paravalvular leak closure of mitral prosthesis from the apical route is effective in reducing the regurgitation grade and improving functional capacity in high-risk patients. Complete closure of the defect was maintained at follow-up in most patients.
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Affiliation(s)
| | | | - Agne Drasutiene
- Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
| | | | - Valdas Bilkis
- Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
| | - Diana Zakarkaite
- Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
| | - Audrius Aidietis
- Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
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García E, Sandoval J, Unzue L, Hernandez-Antolin R, Almería C, Macaya C. Paravalvular leaks: mechanisms, diagnosis and management. EUROINTERVENTION 2014; 8 Suppl Q:Q41-52. [PMID: 22995111 DOI: 10.4244/eijv8sqa9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To understand the incidence, aetiology and mechanisms of paravalvular aortic and mitral leaks after valvular surgery; reviewing the best methods for diagnosis, procedural guidance and result assessment of these leaks, as well as describing the different approaches to their treatment. METHODS AND RESULTS A literature search was undertaken as well as an in-depth analysis of our own experience concerning different imaging modalities and various therapeutic strategies for aortic and mitral paravalvular leaks. The majority of patients were diagnosed using two- or three-dimensional transoesophageal echocardiography, useful in both guiding the procedure as well as assessing the procedural results. Haemoglobin, haematocrit, LDH and haptoglobin values were analysed to assess haemolysis. Procedural success for percutaneous closure of paravalvular aortic leaks are around 90% in the different series, with low complication rates. Mitral leaks have been approached by transfemoral and transapical access; the reported success of this procedure ranges from 75% to more than 90% in different reports. Complication rates at 30 days average 10% and mortality related to the procedure is around 1%. Late follow-up results depend on the initial anatomy, baseline clinical class and procedure results. CONCLUSIONS Paravalvular leaks after surgical valve implantation have a multifactorial aetiology, but are mainly related to specific anatomic characteristics of the valvular ring. Mitral leaks are three times more common than aortic leaks and the incidence increases after reoperation. Different percutaneous techniques with several devices have been explored for leak closure, but we are still lacking devices specifically designed to treat this pathology more effectively.
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Affiliation(s)
- Eulogio García
- Interventional Cardiology, Cardiac Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
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20
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Cruz-Gonzalez I, Rama-Merchan JC, Arribas-Jimenez A, Rodriguez-Collado J, Martin-Moreiras J, Cascon-Bueno M, Luengo CM. Paravalvular leak closure with the Amplatzer Vascular Plug III device: immediate and short-term results. ACTA ACUST UNITED AC 2014; 67:608-14. [PMID: 25037539 DOI: 10.1016/j.rec.2013.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/24/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. METHODS The immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. RESULTS Percutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). CONCLUSIONS Mitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates.
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Affiliation(s)
| | | | | | | | | | - Manuel Cascon-Bueno
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
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21
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Noble S, Jolicoeur EM, Basmadjian A, Levesque S, Nozza A, Potvin J, Crépeau J, Ibrahim R. Percutaneous Paravalvular Leak Reduction: Procedural and Long-term Clinical Outcomes. Can J Cardiol 2013; 29:1422-8. [DOI: 10.1016/j.cjca.2013.07.800] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/15/2013] [Accepted: 07/29/2013] [Indexed: 01/08/2023] Open
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Wunderlich NC, Beigel R, Siegel RJ. The role of echocardiography during mitral valve percutaneous interventions. Cardiol Clin 2013; 31:237-70. [PMID: 23743076 DOI: 10.1016/j.ccl.2013.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transesophageal echocardiography is routinely used to guide percutaneous interventions involving the mitral valve. Mitral balloon valvuloplasty for rheumatic mitral valve stenosis (MS) was the first percutaneous intervention to gain wide acceptance. New techniques have been developed to treat degenerative and functional mitral regurgitation (MR) as well as paravalvular mitral leak (PVML). This review describes the use of echocardiography for transcatheter treatment of MS, MR, and PVML.
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The Amplatzer Vascular Plug: A Review of the Device and its Clinical Applications. Cardiovasc Intervent Radiol 2012; 35:725-40. [DOI: 10.1007/s00270-012-0387-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/25/2012] [Indexed: 12/16/2022]
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