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Belahnech Y, Aguasca GM, García Del Blanco B, Ródenas-Alesina E, González Alujas T, Gutiérrez García-Moreno L, Galian-Gay L, Fernández-Galera R, Irurueta IO, Serra V, Bellera N, Serra B, Calabuig A, Barceló MC, Barrabés JA, Ferreira González I. Impact of a Successful Percutaneous Mitral Paravalvular Leak Closure on Long-term Major Clinical Outcomes. Can J Cardiol 2024; 40:1213-1222. [PMID: 38013065 DOI: 10.1016/j.cjca.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Percutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the impact of successful percutaneous mitral PVL closure on long-term outcomes. METHODS All consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary centre between January 2010 and October 2021 were included. Clinical variables, procedural details, and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFHs) were key secondary endpoints. RESULTS Ninety patients (median age 72.5 years [66.0-78.4]; median EuroSCORE-II 8.2 [5.3-12.46]) were included. Although reduction of at least 1 degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared with the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [CI], 1.41-4.78), cardiovascular death (aHR, 3.53; 95% CI, 1.67-7.49) and HFH (aHR, 3.27; 95% CI,1.72-6.20). CONCLUSIONS A successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death, and HFHs.
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Affiliation(s)
- Yassin Belahnech
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Martí Aguasca
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Bruno García Del Blanco
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa González Alujas
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Gutiérrez García-Moreno
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Galian-Gay
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Rubén Fernández-Galera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Imanol Otaegui Irurueta
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Viçens Serra
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Neus Bellera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Serra
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Calabuig
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Calvo Barceló
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José A Barrabés
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Ferreira González
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Güner A, Kırma C, Ertürk M, Türkmen M, Alıcı G, Karabay CY, Uzun F, Kılıçgedik A, Gündüz S, Güler GB, Kalkan AK, Özkan B, Sarı M, Gürsoy MO, Tekin M, Yıldız M, Can F, Kırali K, Fedakar A, Sarıkaya S, Aydın Ü, Kahraman S, İyigün T, Aksüt M, Karpuzoğlu E, Çiloğlu K, Sungur MA, Tanboğa İH, Özkan M. Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry. J Am Heart Assoc 2024; 13:e032262. [PMID: 38156599 PMCID: PMC10863827 DOI: 10.1161/jaha.123.032262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.
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Affiliation(s)
- Ahmet Güner
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Cevat Kırma
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Mehmet Ertürk
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Muhsin Türkmen
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Gökhan Alıcı
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Can Yücel Karabay
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Fatih Uzun
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Alev Kılıçgedik
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Sabahattin Gündüz
- Department of CardiologyBahçeşehir University, Faculty of MedicineIstanbulTurkey
| | - Gamze Babur Güler
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Ali Kemal Kalkan
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Birol Özkan
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Münevver Sarı
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Mustafa Ozan Gürsoy
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Meltem Tekin
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mustafa Yıldız
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Fatma Can
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Kaan Kırali
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Ali Fedakar
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Sabit Sarıkaya
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Ünal Aydın
- Department of Cardiovascular SurgeryIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Serkan Kahraman
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Taner İyigün
- Department of Cardiovascular SurgeryIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mehmet Aksüt
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Eren Karpuzoğlu
- Department of Cardiovascular SurgeryDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Koray Çiloğlu
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mustafa Azmi Sungur
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology and Biostatistics IstanbulIstanbul Nisantasi UniversityIstanbulTurkey
| | - Mehmet Özkan
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
- Ardahan University, Faculty of Health SciencesArdahanTurkey
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Nakajima H, Tokunaga C, Yoshitake A, Takazawa A. Structures on the ventricular side of the prosthetic valve in extremely late mitral paravalvular leak: a case report. Eur Heart J Case Rep 2023; 7:ytad392. [PMID: 37637100 PMCID: PMC10456207 DOI: 10.1093/ehjcr/ytad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
Background Mechanisms of paravalvular leak (PVL) after mitral valve replacement have not been fully delineated. Herein, we report a case of structures on the ventricular side of the mitral valve in a patient with an extremely late PVL. Case summary A 68-year-old female underwent aortic and mitral valve replacement with a mechanical valve 29 years ago. She was in good health for 28 years. However, exertional dyspnoea appeared 8 months ago. She was admitted to our hospital for congestive heart failure and haemolytic anaemia. Echocardiography showed severe regurgitation due to PVL of the mitral valve. The fluoroscopy showed that a circular calcification was found below the mitral prosthesis. The operation was performed through a median sternotomy. After the aortic cross-clamp, the aortic mechanical valve was removed. The ventricular side of the mitral valve was inspected with the endoscope through the aortic annulus before manoeuvers were performed in the mitral valve. A gap was seen between the prosthetic valve and annular tissue and subvalvular calcification. A bioprosthetic valve was placed with a modified collar-reinforcement technique using a xenopericardium strip. The postoperative course was uneventful. PVL and haemolysis completely disappeared. Discussion The ventricular side of the prosthetic valve could be observed before the mitral valve was removed. Not only the protruding circular calcification and displacement of the prosthetic valve to the atrial side but also the loss of adhesion and adhesive nature of the annular tissue played a definitive role in the late PVL occurrence and recurrence after percutaneous or surgical repair.
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Affiliation(s)
- Hiroyuki Nakajima
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akitoshi Takazawa
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
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Zorinas A, Janušauskas V, Austys D, Davidavičius G, Puodžiukaitė L, Zakarkaitė D, Samalavičius RS, Urbonas K, Kramena R, Onorato EM, Ručinskas K. A Comparison of the Catheter-Based Transapical and Surgical Treatment Modalities for Mitral Paravalvular Leak. J Clin Med 2022; 11:jcm11174999. [PMID: 36078929 PMCID: PMC9457088 DOI: 10.3390/jcm11174999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background: There is a lack of studies where the outcomes of mitral paravalvular leak treatment were compared between surgery and catheter-based closure. The aim of this study was to compare the outcomes of re-do surgery with transapical catheter-based paravalvular leak closure. Methods: This is a retrospective observational study at a single institution; 76 patients were included. According to the treatment, two groups were formed: the “Surgical” group (49 patients after re-do surgery) and the “Catheter” group (27 patients after transapical catheter–based treatment). Results: In-hospital myocardial infarction occurred in 9 (18%) cases in the “Surgical” group and none in the “Catheter” group, p = 0.018. Procedure-related life-threatening bleeding occurred in 9 (18%) patients in the “Surgical” group and none in the “Catheter” group, p = 0.018. Nine (18%) patients died in 30 days in the “Surgical” group, and none died in the “Catheter” group, p = 0.039. A mean follow-up was 3.3 years. No difference was found between the groups by the degree of residual paravalvular regurgitation either at discharge or at follow-up. During the follow-up, 19 (39%) patients died in the “Surgical” group and 2 (7%) among the “Catheter” patients. Conclusions: Transapical catheter-based closure of mitral paravalvular leak seems to be a safer treatment procedure than conventional re-do surgery, and the effectiveness of these procedures does not differ.
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Affiliation(s)
- Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
- Correspondence:
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Donatas Austys
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21/27, LT-03101 Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Lina Puodžiukaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Diana Zakarkaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Robertas Stasys Samalavičius
- Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Karolis Urbonas
- Clinic of Emergency Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Rita Kramena
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
| | - Eustaquio Maria Onorato
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University School of Milan, Via C. Parea 4, 20138 Milan, Italy
| | - Kęstutis Ručinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661 Vilnius, Lithuania
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Giblett JP, Williams LK, Moorjani N, Calvert PA. Percutaneous management of paravalvular leaks. Heart 2021; 108:1005-1011. [PMID: 34686568 DOI: 10.1136/heartjnl-2021-319159] [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: 06/29/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Paravalvular leak (PVL) is a challenging complication of valve replacement surgery that can cause heart failure and haemolysis. Surgical repair is the traditional treatment for severe, symptomatic PVL, but many patients with PVL fall into high-risk categories for redo surgery. Percutaneous techniques for closure of PVL have been increasingly refined over the last decade with availability of approved purpose-specific devices for closure. Percutaneous closure requires a heart team approach, with attention paid to appropriate preprocedural and periprocedural imaging to ensure a successful closure with minimal residual leak or complication. There are limited studies addressing the selection of a percutaneous approach to PVL. No randomised trials comparing surgical and percutaneous repair have been conducted. Large national registries from the UK and Ireland and from Spain have demonstrated that high rates of technical success can be achieved, with mortality comparable with surgical repair. Six retrospective studies comparing surgical and percutaneous approaches have been published. These broadly show comparable technical success between the interventions, with reduced short-term mortality among patients treated percutaneously. Long-term outcomes were similar between both treatment options. Percutaneous repair is an attractive treatment option in many patients due to its reduced invasiveness and quicker recovery period. However, more prospective studies are needed to validate its place in the armamentarium of the heart team.
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Affiliation(s)
- Joel P Giblett
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Lynne K Williams
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK .,Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Abstract
PURPOSE OF REVIEW Given the low occurrence of clinically important paravalvular leak (PVL), there are no large registries or trials in this space to investigate management strategies. This review integrates newer evidence, particularly in imaging guidance for these complex procedures, novel techniques and approaches that our group has taken, as well as approaches to more complex PVL plugging reported in case reports. RECENT FINDINGS Perhaps the largest area of growth in the management of PVL is the use of advanced imaging in both pre-procedure evaluation and intra-procedural guidance with gated cardiac CT, 3D TEE, and fluoroscopy fusion technologies. Outside the USA, a new device, the Occlutech PLD, has become available with early data indicating high success rates. There remains little randomized data to support the efficacy of percutaneous PVL closure. Gated cardiac CT has become key to the pre-procedure evaluation for transcatheter closure as it allows for increased procedural efficiency and more accurate pre-procedure planning, particularly when combined with 3D printing. Intra-procedural TEE-fluoro fusion allows for more rapid crossing of defects by providing a visual target for interventionalists. The advent of purpose-built devices for PVL closure may further increase the efficacy and efficiency of percutaneous closure, but significant barriers remain for approval of these devices in the USA.
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Affiliation(s)
- Aken Desai
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA.
| | - John C Messenger
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - Robert Quaife
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - John Carroll
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
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Pardo Sanz A, Zamorano JL. Imaging techniques: Paving the way for paravalvular leak closure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pardo Sanz A, Zamorano JL. Imaging techniques: Paving the way for paravalvular leak closure. Rev Port Cardiol 2021; 40:271-272. [PMID: 33722448 DOI: 10.1016/j.repc.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ana Pardo Sanz
- Cardiology Department. University Hospital Ramon y Cajal, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department. University Hospital Ramon y Cajal, Madrid, Spain.
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Jang SJ, Truong QA, Bergman G, Wong SC, Mosadegh B. Percutaneous Closure of Aortic and Mitral Paravalvular Leaks—Diagnostic and Therapeutic Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Mitral paravalvular leaks (PVLs) commonly occur in patients with prosthetic valves. Paravalvular defects may be clinically inconsequential and may aggravate hemolysis or cause heart failure through regurgitation. Accordingly, patients may eventually require intervention such as redo surgery or a transcatheter closure of the defects. The introduction of purpose-specific closure devices and new steerable catheters has opened a new frontier for the transcatheter PVL closure. This mode of treatment is an initial therapy in most centers with experienced structural heart team. However, head-to-head data comparing two treatment modalities (surgery and transcatheter closure) are limited, and the world-wide experience is based on nonrandomized studies. Multimodality imaging, including three-dimensional transesophageal echocardiography, facilitates the delineation of mitral PVLs and provides essential data that aids the communication between the members of the structural heart team. In the near future, the success of interventional therapies will most probably increase in patients with mitral PVLs with the introduction of hybrid imaging modalities (echocardiography, cardiac computed tomography, and fluoroscopy). In conclusion, this paper summarizes the etiopathogenesis, clinical characteristics, diagnosis, and treatment of mitral PVLs. (Anatol J Cardiol 2020; 24: 350-60)
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Okutucu S, Mach M, Oto A. Mitral Paravalvular Leak Closure: Transcatheter and Surgical Solutions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:422-431. [DOI: 10.1016/j.carrev.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
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Abordaje percutáneo de las dehiscencias paravalvulares: alternativa a la cirugía o primera opción terapéutica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are associated with substantial morbidity and mortality. Percutaneous closure using occluders specifically designed to improve closure and reduce procedural complications has now become the first-line treatment for PVL. In this Review, we first detail the frequency and clinical consequences of PVL closure. The role of cardiac imaging in the assessment and management of PVL, including echocardiographic imaging and adjunctive techniques such as CT, is then discussed, together with important considerations for the percutaneous closure of PVL, such as access site and device selection. Finally, we summarize the clinical evidence for percutaneous closure of PVL, including large national registries from Ireland, Spain and the UK, as well as head-to-head data comparing this procedure with surgical closure.
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Affiliation(s)
- Joel P Giblett
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Bushra S Rana
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Leonard M Shapiro
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. .,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
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Millán X, Li CH, Arzamendi D. Percutaneous management of paravalvular leaks: an alternative to surgery or first-line therapy. ACTA ACUST UNITED AC 2019; 73:110-113. [PMID: 31708449 DOI: 10.1016/j.rec.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Chi-Hion Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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16
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Alkhouli M, Farooq A, Go RS, Balla S, Berzingi C. Cardiac prostheses-related hemolytic anemia. Clin Cardiol 2019; 42:692-700. [PMID: 31039274 PMCID: PMC6605004 DOI: 10.1002/clc.23191] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022] Open
Abstract
Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis‐related hemolysis.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ali Farooq
- Division of Cardiology, Department of Medicine, West Virginia University, Charleston, West Virginia
| | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sudarshan Balla
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Chalak Berzingi
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
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17
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ACC/AHA Versus ESC Guidelines on Prosthetic Heart Valve Management. J Am Coll Cardiol 2019; 73:1707-1718. [DOI: 10.1016/j.jacc.2019.01.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/15/2022]
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18
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Busu T, Alqahtani F, Badhwar V, Cook CC, Rihal CS, Alkhouli M. Meta-analysis Comparing Transcatheter and Surgical Treatments of Paravalvular Leaks. Am J Cardiol 2018; 122:302-309. [PMID: 29779588 DOI: 10.1016/j.amjcard.2018.03.360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Abstract
Percutaneous paravalvular leak (PVL) closure has emerged as a feasible alternative to redo valve surgery. However, comparative data on percutaneous and surgical treatment of PVL are scarce. We performed a systematic review and a meta-analysis of studies on percutaneous and surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible studies were analyzed. Primary end points were technical success, 30-day mortality, stroke, and length of stay. Secondary end points were 1-year mortality, readmission for heart failure, reoperation, and symptomatic improvement at follow-up. A total of 2,373 patients were included, of whom 1,511 (63.7%) underwent percutaneous closure. Technical success was higher with surgery (96.7% vs 72.1%, odds ratio [OR] 9.7, p <0.001) but at the cost of higher 30-day mortality (8.6% vs 6.8%, OR 1.90, p <0.001), a trend toward higher stroke (3.3% vs 1.4%, OR 1.94, p = 0.069), and longer hospitalizations. However, surgery was associated with similar 1-year mortality (17.3% vs 17.2%, OR 1.07, p = 0.67), reoperation (9.1% vs 9.9%, OR 0.72, p = 0.1), readmission for heart failure (13.3% vs 26.4%, OR 0.51, p = 0.29), and improvement in New York Heart Association classification (67.4% vs 56%, OR 1.37, p = 0.74), compared with percutaneous closure. A sensitivity analysis including comparative studies only yielded similar results. Surgical treatment of PVL achieves higher technical success rates but is associated with higher early morbidity and mortality compared with percutaneous closure. Nevertheless, mortality rates and clinical efficacy parameters were similar at midterm with both procedures. Further studies are warranted to identify the ideal management approach to patients with symptomatic PVL.
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19
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Bouhout I, Ghoneim A. Rethinking Mitral Paravalvular Leak Closure. JACC Cardiovasc Interv 2017; 10:1957-1958. [DOI: 10.1016/j.jcin.2017.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022]
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20
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Strategies for Paravalvular Prosthetic Leak Closure. JACC Cardiovasc Interv 2017; 10:1970-1972. [DOI: 10.1016/j.jcin.2017.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 11/20/2022]
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