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Flores-Umanzor E, Cepas-Guillén P, Ruberti A, Regueiro A, Sanchis L, Gabani R, Rodés-Cabau J, Vidal B, Freixa X. Paravalvular leak closure after TAVI with plugs: A literature review with a specific focus on arterio-arterial loop. Catheter Cardiovasc Interv 2024. [PMID: 38984656 DOI: 10.1002/ccd.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
More than mild paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) is associated with a twofold increase in all-cause mortality, heart failure hospitalizations, and the need for reintervention. Successfully addressing PVL in TAVIs is more challenging than in surgical valves. The arterial-arterial (A-A) rail technique emerges as a valuable strategy for post-TAVI PVL closure, enhancing success rates by enabling the effective use of lower-profile vascular plug devices. When standard approach is ineffective, generating an A-A loop for post-TAVI PVL closure is probably the most recommended strategy to ensure procedural success.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Cepas-Guillén
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andrea Ruberti
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ander Regueiro
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Sanchis
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rami Gabani
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Rodés-Cabau
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Barbara Vidal
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Hascoët S, Smolka G, Blanchard D, Kloëckner M, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Dumonteil N, Bauer F, Nejjari M, Pillière R, Dauphin C, Bonnet G, Ciobotaru V, Kételers R, Gallet R, Hammoudi N, Mangin L, Bouvaist H, Spaulding C, Aminian A, Kilic T, Popovic B, Armero S, Champagnac D, Gérardin B. Predictors of Clinical Success After Transcatheter Paravalvular Leak Closure: An International Prospective Multicenter Registry. Circ Cardiovasc Interv 2022; 15:e012193. [PMID: 36256693 DOI: 10.1161/circinterventions.122.012193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of a symptomatic prosthetic paravalvular leak (PVL) is feasible, but there is presently no conclusive evidence to show consistent efficacy. We aimed to identify predictors of clinical success after transcatheter PVL closure. METHODS Consecutive patients referred to 24 European centers for transcatheter PVL closure in 2017 to 2019 were included in a prospective registry (Fermeture de Fuite ParaProthétique, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death. RESULTS We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. Symptoms were heart failure, hemolytic anemia, or both in 48.9%, 7.8%, and 43.3% of patients, respectively. One, 2, and 3 leaks were treated during the same procedure in 69.6%, 26.6%, and 3.8% of patients, respectively. The PVL was pinpoint or involved 1/8 or 1/4 of the valve circumference in 18.6%, 52.4%, and 28.1% of cases, respectively. The most frequently used devices were the Vascular Plug 3, Ventricular Septal Defect Occluder, Vascular Plug 2, and Paravalvular Leak Device (45.0%, 16.6%, 14.2%, and 13.6% of cases, respectively). Successful device(s) implantation with leak reduction to ≤grade 2 was obtained in 85.0% of mitral and 91.4% of aortic procedures, respectively (P=0.164); with major periprocedural adverse event rates of 3.3% and 1.2%, respectively (P=0.371); and clinical success rates of 70.3% and 88.0%, respectively (P=0.004). By multivariate analysis, technical failure, mechanical valve, and hemolytic anemia were independently associated with absence of clinical success (odds ratios [95% CIs], 7.7 [2.0-25.0]; P=0.002; 3.6 [1.1-11.1]; P=0.036; and 3.7 [1.2-11.9]; P=0.025; respectively). CONCLUSIONS Transcatheter PVL closure is efficient and safe in symptomatic patients but is associated with a lower clinical success rate in patients with hemolysis and/or a mechanical valve. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT05089136.
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Affiliation(s)
- Sébastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | | | - David Blanchard
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Martin Kloëckner
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
| | - Eric Brochet
- Hôpital Bichat AP-HP, Hôpital Bichat-Paris, Paris, France (E.B.)
| | - Frederic Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Hôpital Rangueil, CHU Toulouse, Toulouse, France (F.B.)
| | - Guillaume Leurent
- Department of cardiology, Université Rennes, Inserm, LTSI - UMR1099, CHU Rennes, Rennes, France (G.L.)
| | | | | | | | | | | | - Rémy Pillière
- Clinique Ambroise Paré-25-27 boulevard Victor Hugo, France (R.P.)
| | - Claire Dauphin
- Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France (C.D.)
| | - Guillaume Bonnet
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, France (G.B.)
| | | | | | | | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, and Hôpital Pitié-Salpêtrière AP-HP, Boulevard de l'Hôpital, Paris, France (N.H.)
| | - Lionel Mangin
- Hôpital d'Annecy, 1 avenue de l'Hôpital, France (L.M.)
| | - Hélène Bouvaist
- CHU Grenoble, avenue du Maquis du Grésivaudan, France (H.B.)
| | | | | | - Teoman Kilic
- Kocaeli University School of Medicine, Cardiology Department, Umuttepe, Yerteskesi, Kocaeli, Turkey (T.K.)
| | - Batric Popovic
- Lorraine University, CHRU Nancy, Cardiology department, Nancy, France (B.P.)
| | | | | | - Benoît Gérardin
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, France (S.H., D.B., M.K., B.G.)
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Janmohamed IK, Mishra V, Geragotellis A, Sherif M, Harky A. Mitral valve paravalvular leaks: Comprehensive review of literature. J Card Surg 2021; 37:418-430. [PMID: 34822197 DOI: 10.1111/jocs.16145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms. AIMS This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs. METHODS A comprehensive literature search was performed using PubMed, EMBASE, Cochrane database, Google Scholar and Ovid. Search terms used included "mitral valve paravalvular leak," "transthoracic echocardiography," "2D transoesophageal echocardiography," "3D transoesophageal echocardiography," "cardiac computed tomography," (CT) "cardiac magnetic resonance imaging," "intracardiac echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous closure." RESULTS All patients with mPVLs should undergo regular full evaluation, including patient history, physical examination, laboratory work-up, imaging, and referral, if necessary. Echocardiography is fundamental to the diagnosis, and is augmented with cardiac magnetic resonance imaging, cardiac computerized tomography and fluoroscopy for further characterization and procedural planning amongst the structural heart team. CONCLUSION The prevalence of mPVL is expected to increase proportionally to the growing number of surgical and transcatheter valve replacements conducted in the ageing population. Multimodal imaging is instrumental in guiding diagnostic and therapeutic strategies when managing mPVLs. Advances in imaging and capabilities of transcather devices will prompt growing uptake of percutaneous treatment over conventional, higher-risk surgery for mPVL management.
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Affiliation(s)
| | - Vaibhav Mishra
- St. George's University of London Medical School, Tooting, London, UK
| | - Alexander Geragotellis
- Faculty of Health Sciences, Observatory, University of Cape Town School of Medicine, Cape Town, South Africa
| | - Mohamed Sherif
- Department of Cardiothoracic, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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