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Chan N, Dong T, Sabbak N, Xu B, Wang TKM. Contemporary Review of Transcatheter Mitral Valve Interventions for Mitral Regurgitation. Life (Basel) 2023; 13:1511. [PMID: 37511886 PMCID: PMC10381253 DOI: 10.3390/life13071511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Mitral regurgitation (MR) is the most common form of valvular heart disease in the United States, and there are established guidelines for indications for requiring mitral valve surgeries. However, there is an unmet clinical need for a subset of high-risk MR patients, especially those with advanced age, heart failure and/or secondary MR. Following the successes of transcatheter aortic valve replacements, significant advances have occurred over the last decade in transcatheter mitral valve interventions in order to manage these patients in both clinical practice and trials. The three main types of these interventions include a transcatheter edge-to-edge repair, percutaneous mitral annuloplasty (both direct and indirect) and transcatheter mitral valve replacement (including when applied to a prior prosthetic valve, annuloplasty ring and mitral annuloplasty ring). This review aims to discuss the contemporary techniques, evidence, indications, multimodality imaging evaluations and outcomes of the various transcatheter mitral valve interventions.
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Affiliation(s)
- Nicholas Chan
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Nabil Sabbak
- Section of Invasive and Interventional Cardiology Section, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
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2
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Fiore A, Piscitelli M, Rabia A, Folliguet T, Nappi F, Gallet R. Surgery for delayed leaflet impingement after transcatheter closure of a paravalvular leak associated with an aortic pseudoaneurysm. Perfusion 2023; 38:432-435. [PMID: 35289195 DOI: 10.1177/02676591211057505] [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: 11/16/2022]
Abstract
Background: Paravalvular leak (PVL) is a recognized and challenging complication after surgical or transcatheter valve replacement. The transcatheter closure of PVL has become the first-line treatment in clinical practice when the procedure is not contraindicated. Transcatheter PVL closure rests on a complex procedure and complications still occur in approximately 9% of patients. Case Report: We describe the case of a delayed mechanical prosthetic leaflet impingement after transcatheter closure of a paravalvular leak associated with a Valsalva pseudoaneurysm that required an urgent surgery. Conclusion: Aorta-left ventricle communication could be a relative contraindication to be assessed on a case-by-case basis, but transcatheter closure does not preclude subsequent attempt for surgical repair and outcome.
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Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, 378967Hôpitaux Universitaires Henri Mondor, Créteil, France.,Advanced Surgical Technologies, Sapienza University of Rome, Rome, Italy
| | | | - Amel Rabia
- Department of Cardiac Surgery, 378967Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, 378967Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Francesco Nappi
- Department of Cardiac Surgery, 56509Centre Cardiologique du Nord, Saint-Denis, France
| | - Romain Gallet
- Department of Cardiology, 378967Hôpitaux Universitaires Henri Mondor, Créteil, France
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3
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Hascoët S, Smolka G, Kilic T, Ibrahim R, Onorato EM, Calvert PA, Champagnac D, Freixa-Rofastes X, Zorinas A, Sandoval JP, Ducrocq G, Bouisset F, Fraisse A, Gerardin B. Procedural Tools and Technics for Transcatheter Paravalvular Leak Closure: Lessons from a Decade of Experience. J Clin Med 2022; 12:jcm12010119. [PMID: 36614920 PMCID: PMC9820878 DOI: 10.3390/jcm12010119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Prosthetic paravalvular leaks (PVLs) are associated with congestive heart failure and hemolysis. Surgical PVL closure carries high risks. Transcatheter implantation of occluding devices in PVL is a lower risk but challenging procedure. Of the available devices, only two have been specifically approved in Europe for transcatheter PVL closure (tPVLc): the Occlutech® Paravalvular Leak Device (PLD) and Amplatzer™ ParaValvular Plug 3 (AVP 3). Here, we review the various tools and devices used for tPVLc, based on three observational registries including 748 tPVLc procedures performed in 2005-2021 at 33 centres in 11 countries. In this case, 12 registry investigators with over 20 tPVLc procedures each described their practical tips and tricks regarding imaging, approaches, delivery systems, and devices. They considered three-dimensional echocardiography to be the cornerstone of PVL assessment and procedure guidance. Anterograde trans-septal mitral valve and retrograde aortic approaches were used in most centres, although some investigators preferred the transapical approach. Hydrophilic-coated low-profile sheaths were used most often for device deployment. The AVP 3 and PLD devices were chosen for 89.0% of procedures. Further advances in design and materials are awaited. These complex procedures require considerable expertise, and experience accumulated over a decade has no doubt contributed to improve practices.
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Affiliation(s)
- Sébastien Hascoët
- Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France
- Royal Brompton Hospital, Sydney Street, London SW3 6PY, UK
- Correspondence:
| | - Grzegorz Smolka
- Department of cardiology, Medical University of Silesia—Poniatowskiego 15, 40-055 Katowice, Poland
| | - Teoman Kilic
- Department of Cardiology, Medical Faculty, Kocaeli University, Umuttepe, Yerteskesi, Kocaeli 41380, Turkey
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada
| | | | - Patrick A. Calvert
- Department of Cardiology, Royal Papworth Hospital, NHS Foundation Trust, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0AY, UK
| | - Didier Champagnac
- Médipôle Lyon Villeurbanne, 158 rue Léon Blum, 69100 Villeurbanne, France
| | - Xavier Freixa-Rofastes
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08306 Barcelona, Spain
| | - Aleksejus Zorinas
- Vilnius University Hospital Santaros Klinikos, Vilnius University, 08410 Vilnius, Lithuania
| | - Juan Pablo Sandoval
- Ignacio Chávez National Institute of Cardiology, Universidad La Salle, Mexico City 14080, Mexico
| | - Gregory Ducrocq
- Bichat Hospital, Assistance Publique des Hôpitaux de Paris, Hôpital Bichat-Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Frederic Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Hôpital Rangueil, CHU Toulouse, 1 Avenue du Pr Jean Poulhès, 31000 Toulouse, France
| | - Alain Fraisse
- Royal Brompton Hospital, Sydney Street, London SW3 6PY, UK
| | - Benoit Gerardin
- Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France
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4
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Muncan B, Amabile A, Kalogeropoulos AP, Geirsson A, Krane M. Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score-matched analysis. J Card Surg 2022; 37:4391-4396. [PMID: 36168792 DOI: 10.1111/jocs.16972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current literature reports better short-term mortality rates in mitral valve repair over replacement in elderly patients. However, valve durability, postoperative complications, and reintervention rates in these cohorts remain understudied. As such, we aimed to investigate 5-year rates of mortality and reoperation after initial mitral repair or replacement in elderly patients. METHODS Using the TriNetX Research Network database, we identified patients aged ≥70 who underwent mitral valve repair or replacement for nonrheumatic mitral insufficiency between January 2010 and December 2020. We 1:1 propensity score-matched cohorts for 33 covariates including demographics, comorbidities, and surgical history. After matching, we compared 5-year mortality and reoperation rates between cohorts using Kaplan-Meier estimates and multivariable Cox proportional hazards models. RESULTS We compared 823 mitral valve repair patients to a propensity score-matched cohort of 823 mitral valve replacement patients over a 5-year follow-up period. All variables of interest were adequately matched. Cumulative 5-year mortality rate was significantly lower among mitral valve repair patients (17.0% vs. 24.9%; hazard ratio [HR]: 0.66, 95% confidence interval [95% CI]: 0.51-0.87, p < 0.0025). Reoperation rates at 5-year did not differ (2.6% vs. 2,1%; HR: 1.34, 95% CI: 0.67-2.68, p = 0.401). CONCLUSIONS We observed lower 5-year mortality rates and nonsignificantly different reoperation rates among elderly patients with mitral regurgitation undergoing mitral valve repair compared to replacement. Our data support the current understanding that mitral valve repair should be considered as the first treatment line whenever possible, even in elderly patients.
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Affiliation(s)
- Brandon Muncan
- Division of Cardiology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Calcific mitral valve disease: The next challenging disease. Arch Cardiovasc Dis 2022; 115:613-616. [PMID: 36347773 DOI: 10.1016/j.acvd.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
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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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7
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Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience. J Clin Med 2022; 11:jcm11164835. [PMID: 36013075 PMCID: PMC9409651 DOI: 10.3390/jcm11164835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.
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Onorato EM, Vercellino M, Costante A, Bartorelli AL. Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function? Front Cardiovasc Med 2022; 9:839159. [PMID: 35833184 PMCID: PMC9272523 DOI: 10.3389/fcvm.2022.839159] [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: 12/19/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Aortic paravalvular leak (APVL) after surgical valve replacement (AVR) is an ominous complication with a high risk of morbidity and mortality. Approximately 1–5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or hemolytic anemia. Case Summary A 69-year-old man with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical tilting disc prosthetic valve (Medtronic Starlight 27 mm). Several years later, recurrent episodes of congestive heart failure and hemolytic anemia developed due to a large crescent-shaped aortic PVL located at non coronary cusp (NCC) 9–12 o'clock, with moderate-to-severe regurgitation. The patient was deemed at prohibitive surgical risk due to significant multiple comorbidities and a transcatheter PVL closure (TPVLc) was planned. The huge PVL was partially closed by a first specifically designed paravalvular leak device (PLD). The procedure was complicated by transient interference of the second PLD with mechanical prosthetic valve function. This issue has however been solved with correct manipulation, orientation and downsizing of the second device implanted. At 3-month and 13-month follow-up, the patient showed a relevant clinical improvement and good quality of life. 2D TTE color Doppler confirmed the stable position of the two PLDs with trace residual leak. Discussion Surgical redo has been considered the treatment of choice for symptomatic patients with PVLs. Notwithstanding, TPVLc is a less invasive alternative, particularly in patients at high surgical risk in whom early diagnosis and prompt interventional treatment are crucial for improving expectancy and quality of life. Dedicated devices, appropriate procedural techniques, and the close interaction between imaging modalities, allowed to deal successfully with a challenging case of severe symptomatic aortic PVL.
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Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- *Correspondence: Eustaquio Maria Onorato ; orcid.org/0000-0002-6750-5682
| | - Matteo Vercellino
- Cardiology Department, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Annamaria Costante
- Cardiology Department, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
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9
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Smeltz AM, Merlo A, Ikonomidis JS, Vavalle JP, Kolarczyk LM. Paravalvular Leak Immediately Following Repeat Mitral Valve Replacement: Considerations for Repair in a High-Risk Patient. J Cardiothorac Vasc Anesth 2022; 36:3945-3954. [DOI: 10.1053/j.jvca.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
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10
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Willner N, Burwash IG, Beauchesne L, Chan V, Vulesevic B, Ascah K, Coutinho T, Promislow S, Stadnick E, Chan KL, Mesana T, Messika-Zeitoun D. Natural History of Mitral Annulus Calcification and Calcific Mitral Valve Disease. J Am Soc Echocardiogr 2022; 35:925-932. [PMID: 35618253 DOI: 10.1016/j.echo.2022.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/05/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The natural history of mitral annular calcification (MAC) and risk for developing calcific mitral valve disease (CMVD) has been poorly defined. We sought to evaluate the progression rate of MAC and of the development of CMVD. METHODS Patients with MAC and paired echocardiograms at least one year apart between 2005 and 2019 were included. Progression rates from mild/moderate to severe MAC and to CMVD (defined as severe MAC and significant mitral stenosis and/or regurgitation) were assessed, along with potential association with sex. RESULTS A total of 11,605 patients (73±10years, 51%male) with MAC (78% mild, 17% moderate, 5% severe) were included and had a follow up echocardiogram at 4.2±2.7years. In patients with mild/moderate MAC, 33% presented with severe MAC at 10 years. The rate of severe MAC was higher in females than in males (41% vs. 24%, P<0.001, HR=1.3, P<0.001) and in patients with moderate vs. mild MAC (71% vs. 22%, P<0.001, HR=6.1, P<0.001). At 10 years 10% presented with CMVD (4%, 23% and 60% in patients with mild, moderate, and severe MAC respectively) and was predicted by female sex (15% vs. 5%, P<0.0001), even after adjustment for MAC severity (HR=1.9, P<0.001). CONCLUSION In this large cohort of patients with MAC, progression to severe MAC was common and frequently results in CMVD. Female sex was associated with higher progression rates. MAC and CMVD are expected to dramatically increase as the population ages highlighting the importance of a better understanding of the pathophysiology of MAC in order to develop effective preventive medical therapies.
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Affiliation(s)
- Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Luc Beauchesne
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Vince Chan
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Branka Vulesevic
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kathy Ascah
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Thias Coutinho
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steve Promislow
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ellamae Stadnick
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kwan L Chan
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Thierry Mesana
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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11
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Love BA, Cabalka AK, Rihal CS. Paravalvular Leak Closure and Ventricular Septal Defect Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Sozzi F, Hugues N, Schiavone M, Levy F, Civaia F, Iacuzio L, Rossi P, Carugo S, Bourlon F, Eker A. Percutaneous closure of a paravalvular prosthetic mitral leak complicated by need for acute hemodialysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:172-175. [PMID: 34480493 DOI: 10.1002/jcu.23059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
A case of a severe paravalvular mechanical mitral prosthesis leak (PVL) in a high-risk surgical patient, complicated with acute heart failure at presentation is described. Considering the high surgical risk and the specific echocardiographic features that would prevent the interventional cardiologist to have a direct access to the PVL with a traditional vascular plug or duct occluder, a percutaneous PVL closure with an Amplatzer-Amulet (Abbott, Abbott Park, Illinois, United States) LAA device (28 mm) was chosen for the contiguity of the PVL to the left atrial appendage (LAA). A new-onset hemolysis post-PVL closure and severe renal failure requiring hemodialysis occurred after the procedure, treated with surgical device removal and leak suture. To the best of our knowledge, this is the first case that describes the attempt to close a PVL, contiguous to the LAA, using the Amulet device. The attempt to close a PVL with these features with an Amplatzer-Amulet device, although promising, does not appear completely safe to reach the goal, as in our case. In our opinion, the most important reasons are that specific technical recommendations and broad experiences are lacking. Indeed, specific outcomes of this kind of approach are, to date, still unknown.
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Affiliation(s)
- Fabiola Sozzi
- Cardiothoracic Centre of Monaco, CCM, Monaco (MC)
- Fondazione Maggiore Policlinico IRCCS Cà Granda, Milan, IT
| | | | | | - Frank Levy
- Cardiothoracic Centre of Monaco, CCM, Monaco (MC)
| | | | | | | | - Stefano Carugo
- Fondazione Maggiore Policlinico IRCCS Cà Granda, Milan, IT
| | | | - Armand Eker
- Cardiothoracic Centre of Monaco, CCM, Monaco (MC)
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13
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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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14
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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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15
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Sudhakaran S, Tandon A, Rafael AE, Choi JW. Severe Mitral Paravalvular Leak Treated with Percutaneous Paravalvular Leak Closure with Underlying Severe Mitral Annular Calcium. Am J Cardiol 2021; 152:165-167. [PMID: 34162483 DOI: 10.1016/j.amjcard.2021.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Standard operative mitral valve replacement for mitral stenosis in the setting of severe mitral annular calcium has been associated with increased morbidity and mortality. Inability to ensure a well seated prosthesis may lead to periprosthetic leak. We present a case of severe paravalvular leak, causing significant hemolysis, after mitral valve replacement with underling severe mitral annular calcium. The leak was successfully repaired using a transseptal percutaneous approach, with subsequent resolution of hemolysis.
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16
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Wei S, Ren T, Zhang L, He X, Li L, Jiang S. Thoracoscopic-assisted Repair of Perivalvular Leakage of Prosthetic Mitral Valve. Ann Thorac Surg 2021; 112:e431-e433. [PMID: 33737044 DOI: 10.1016/j.athoracsur.2021.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
Perivalvular leakage(PVL) after valve replacement is an awkward complication, and is liable to recur if re-replacement of a prosthetic valve is attempted. An 58-year-old male received initial mitral valve replacement 17 years earlier and developed PVL in mitral position recently. In this case we attempt an alternative way to repair mitral perivalvular leakage through a mini thoraoctomy with thoraoscopic assistance without valve re-replacement surgery. The patient recovered uneventfully and was discharged on the 7th day after operation. Echocardiography revealed no regurgitation or new PVL developing during the 3 months follow-up.
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Affiliation(s)
- Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Tong Ren
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Zhang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaoyi He
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lianggang Li
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
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17
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Transcatheter Mitral Valve Implantation Systematic Review: Focus on Transseptal Approach and Mitral Annulus Calcification. Curr Cardiol Rep 2021; 23:37. [PMID: 33687594 DOI: 10.1007/s11886-021-01466-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This systematic review was performed to evaluate the results of transcatheter mitral valve implantation (TMVI) in the native mitral valve. EVIDENCE ACQUISITION Medline, EMBASE, and the Cochrane Central register were systematically searched for studies that reported results of TMVI in mitral valve regurgitation and/or stenosis and mitral annular calcification. To improve the sensitivity of the literature search, we performed citation chasing in Google Scholar, Scopus, and Web of Science. EVIDENCE SYNTHESIS Twelve studies reporting results of TMVI in mitral regurgitation were retrieved and included 347 patients. The transseptal approach represented 28% of cases. Secondary mitral regurgitation was the predominant indication in 63% of cases. Thirty-day mortality was 11% and was lowered with the transseptal approach (7%). Technical success was 92%. Surgical conversion was needed in 5% of patients. Only one patient presented moderate to severe mitral regurgitation. These hemodynamic results were sustainable up to one year of follow-up. Three series focused on results of TMVI in mitral annulus calcification including 167 patients. Only nine patients were treated with TMVI dedicated prosthesis. Eighty-seven patients had their prosthesis delivered through a transseptal approach. Mitral stenosis was present in 63% of cases. Thirty-day mortality was 24%, and none with TMVI prosthesis. Technical success was achieved in 71% of cases and was improved by using TMVI prosthesis (89%). The main complication was left ventricular outflow tract obstruction (20%). Post procedural moderate to severe mitral regurgitation was observed in 4% of cases. CONCLUSION TMVI seems to be feasible, achieving good technical success and predictable and durable MR reduction.
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18
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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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19
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Yajima S, Fukushima S, Yamashita K, Shimahara Y, Tadokoro N, Kakuta T, Sakaniwa R, Kobayashi J, Fujita T. Long-term outcomes after reoperation for mitral paravalvular leaks: a single-centre experience. Eur J Cardiothorac Surg 2020; 59:ezaa331. [PMID: 32944776 DOI: 10.1093/ejcts/ezaa331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We aimed to analyse the pathology of paravalvular leak (PVL), and determine the long-term outcomes of redo mitral valve replacement and risk factors of all-cause mortality. METHODS Seventy-nine patients (mean age 70 ± 9 years; 54 female, 68%) who underwent redo mitral valve replacement for mitral PVL between January 2000 and May 2019 were retrospectively reviewed. Indications for PVL intervention were haemolytic anaemia (57/79, 72%), New York Heart Association class III/IV congestive heart failure (56/79, 71%) and prosthetic valve endocarditis with PVL (2/79, 3%). RESULTS PVL most commonly occurred at lateral sectors (42/79, 55%). Early mortality occurred in 2 patients (3%) due to low cardiac output syndrome. Two patients (3%) had residual PVL at discharge. Sixteen patients (23%) developed late PVL (mean follow-up, 3.4 ± 2.9 years), among whom 11 (69%) developed PVL at same area as that preoperatively. Additionally, 9 patients (56%) developed PVL at lateral sectors in late follow-up. At 1, 5 and 10 years, the survival rate was 93%, 72% and 45%; rate of freedom from cardiac death was 96%, 92% and 78%; and rate of freedom from PVL recurrence was 94%, 82% and 54%, respectively. Chronic kidney disease was the only risk factor in the multivariate analysis for mortality [P = 0.013; hazard ratio 4.0 (1.4-11.0)]. CONCLUSIONS Surgery for mitral PVL confers reasonable early and long-term outcomes. Greater attention to the anterolateral annulus may help prevent PVL.
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Affiliation(s)
- Shin Yajima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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20
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Abstract
Intravascular hemolysis is a known complication of prosthetic heart valves. Severe hemolysis is rare (<1%) with the use of newer generation prosthetic valves. This usually occurs due to paravalvular leaks (PVLs). We present a case of hyperbilirubinemia and hemolytic anemia occurring as a result of a PVL of a prosthetic mechanical mitral valve. The patient was a 49-year-old female with a past medical history of rheumatic heart disease status following two mitral valve replacements each with a mechanical prosthesis; she presented with a complaint of worsening fatigue, epigastric pain, nausea, and vomiting. On examination, she had scleral icterus. Heart auscultation revealed a crisp mechanical S1 click and a soft 2/6 systolic murmur in the left lower sternal border. Her abdomen was soft with mild epigastric and right upper quadrant tenderness, and no Murphy’s sign. Her labs revealed a white blood cell count of 7.0 x 103/microliter, hemoglobin 10.5 g/dL, hematocrit 29.7%, total bilirubin 6.9 mg/dL, direct bilirubin 0.8 mg/dL, alkaline phosphatase (ALP) 62 U/L, aspartate aminotransferase (AST) 79 U/L, and alanine aminotransferase (ALT) 56 U/L. An ultrasound of the abdomen revealed cholelithiasis without pericholecystic fluid collection and no ultrasonographic Murphy’s sign. Magnetic resonance cholangiopancreatography ruled out acute cholecystitis or intra- or extra-hepatic biliary ductal dilatation. A transesophageal echocardiogram showed a well-seated mitral valve prosthesis with a significant PVL and likely moderate mitral regurgitation. The patient was evaluated for possible hemolysis. Lactate dehydrogenase was 1155 U/L, haptoglobin was <30 mg/dL, and reticulocyte count was 5.2%. She underwent a mitral valve re-replacement with a mechanical prosthesis. An echocardiogram after the surgery showed the mechanical prosthesis mitral valve with no residual PVL.
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Affiliation(s)
- Maitreyee Rai
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
| | | | - Charles Geller
- Cardiothoracic Surgery, Crozer-Chester Medical Center, Upland, USA
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21
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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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22
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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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23
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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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24
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Shah VN, Orlov OI, Orlov CP, Buckley M, Sicouri S, Takebe M, Thomas MP, Goldman SM, Plestis KA. Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:519-530. [DOI: 10.1177/1556984519874806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. Methods: A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. Results: The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. Conclusions: The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.
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Affiliation(s)
- Vishal N. Shah
- Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA, USA
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Oleg I. Orlov
- Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA, USA
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Cinthia P. Orlov
- Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA, USA
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Meghan Buckley
- Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Manabu Takebe
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Matthew P. Thomas
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Scott M. Goldman
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA
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25
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Characteristics and longer-term outcomes of paravalvular leak after aortic and mitral valve surgery. J Thorac Cardiovasc Surg 2019; 157:1785-1792.e1. [DOI: 10.1016/j.jtcvs.2018.08.096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/19/2018] [Accepted: 08/11/2018] [Indexed: 02/05/2023]
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26
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Bertrand PB, Mihos CG, Yucel E. Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:19. [PMID: 30929092 DOI: 10.1007/s11936-019-0723-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options. RECENT FINDINGS Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential. MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.
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Affiliation(s)
- Philippe B Bertrand
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA
| | - Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA.
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27
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Greenbaum AB, Frisoli TM. Surgical Paravalvular Leak Closure: No More Second Chances. JACC Cardiovasc Interv 2019; 10:508-509. [PMID: 28279318 DOI: 10.1016/j.jcin.2017.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Adam B Greenbaum
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan.
| | - Tiberio M Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
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28
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Cubeddu RJ, Crespo HJ, Novaro GM. Retrograde transmitral paravalvular leak closure through an antegrade transseptal approach: A novel technique. Catheter Cardiovasc Interv 2018; 92:1196-1200. [PMID: 29330899 DOI: 10.1002/ccd.27482] [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: 08/22/2017] [Accepted: 12/17/2017] [Indexed: 11/06/2022]
Abstract
Mitral paravalvular leak (PVL) remains a well-known complication after mitral valve replacement. Since the first report over 25 years ago, several catheter-based PVL closure techniques have been described. Most of these comprise of either an antegrade transseptal approach, or a retrograde transaortic or transapical approach. We herein report a novel percutaneous mitral PVL closure technique that was safely and successfully performed after failed attempt using a conventional antegrade approach.
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Affiliation(s)
| | - Hector J Crespo
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - Gian M Novaro
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
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29
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Tanner R, Hassan S, Ryan N, Murphy NF, Campbell P, Margey R, Walsh K, Byrne R, Blake G, Casserly IP. Trans-catheter paravalvular leak closure: a single-centre experience. Ir J Med Sci 2018; 188:489-496. [PMID: 30209725 DOI: 10.1007/s11845-018-1895-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A significant paravalvular leak (PVL) is estimated in at least 1-3% of patients undergoing surgical aortic and/or mitral valve replacement. Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL has emerged as an alternative to surgical repair. AIM We sought to examine the clinical outcomes of patients treated with percutaneous closure of PVL at an Irish tertiary referral centre. METHODS A prospective registry was used to record patient and procedural characteristics at the time of the PVL procedure. Medical records were retrospectively reviewed to assess clinical outcomes during the index hospitalisation and at follow-up. RESULTS A total of 26 PVL procedures were performed in 21 patients (mean age 68 ± 13 years, 76% male). Heart failure (HF), haemolysis (HL) or a combination of both was the presenting symptoms in 62%, 24% and 14% of patients, respectively. In the entire cohort, clinical success was achieved in 18 patients (86%). Clinical success was achieved more frequently when HF was the clinical indication compared to HL (100% versus 66%). Among patients presenting with isolated HF (n = 13), the mean NYHA class at baseline and follow-up was 2.5± 0.7 and 1.4± 0.7, respectively. Thirty-day mortality was 0%. There was one (3.8%) major adverse procedural complication (stroke). A total of six deaths (28%) occurred during follow-up (22 ± 13.4 months). CONCLUSIONS Patients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in those patients who present primarily with HF.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Saber Hassan
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Vancouver General Hospital, Vancouver, Canada
| | - Nicola Ryan
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Royal Infirmary, Foresterhill, Aberdeen, Scotland
| | - Niamh F Murphy
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Patricia Campbell
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ronan Margey
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Kevin Walsh
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Roger Byrne
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. .,Mater Private Hospital, Eccles Street, Dublin 7, Ireland.
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Hernández-Enríquez M, Freixa X, Quintana E, Pereda D, Sandoval E, Sabaté M. Corrección de fugas paravalvulares: buscando el equilibrio entre las técnicas quirúrgicas y percutáneas. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Verdonk C, Cimadevilla C, Lepage L, Perez F, Ghodbane W, Raffoul R, Alkhoder S, Nataf P, Vahanian A, Messika-Zeitoun D. Systematic transoesophageal echocardiography after mitral valve replacement: Rates and determinants of paravalvular regurgitation. Arch Cardiovasc Dis 2018; 111:528-533. [PMID: 30030045 DOI: 10.1016/j.acvd.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 10/28/2022]
Abstract
BACKGROUND With the emergence of transcatheter mitral valve replacement, it appears crucial to provide contemporary references with which this new technology can be compared. At our institution, transoesophageal echocardiography is systematically performed before discharge after surgical mitral valve replacement. AIM To evaluate the rate and determinants of paravalvular regurgitation after surgical mitral valve replacement. METHODS We collected medical history, indication, type of surgery and in-hospital outcome in all consecutive patients who underwent a mitral valve replacement in the past 2 years at our institution. Paravalvular regurgitation was assessed semiquantitatively using transoesophageal echocardiography before discharge. RESULTS We enrolled 399 patients (mean age 61±16 years; 58% women; 27% with a history of cardiac surgery). Mitral valve replacement was performed mainly for rheumatic disease (44%). Most patients were severely symptomatic (70% in New York Heart Association class III/IV). A mechanical prosthesis was implanted in 60% and a bioprosthesis in 40%. In-hospital mortality was 10%. Transoesophageal echocardiography was performed in 310 patients (77%); the main reasons for not performing transoesophageal echocardiography were frailty (n=40, 10%), early death (n=19, 5%) and contraindication for transoesophageal echocardiography (n=10, 3%). The overall rate of paravalvular regurgitation was 8% (n=25); a grade ≥2 was observed in five patients (2%), and two patients had to be reoperated on. Mitral annular calcification was the main factor associated with paravalvular regurgitation (P=0.01). CONCLUSIONS Surgical mitral valve replacement was associated with significant in-hospital mortality and morbidity. Using systematic transoesophageal echocardiography assessment, paravalvular regurgitation was not uncommon (8%), and was significantly linked to mitral annulus calcification. However, clinically significant leakage (≥grade 2) was rare (2%).
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Affiliation(s)
- Constance Verdonk
- Department of Cardiology, Bichat Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Claire Cimadevilla
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Laurent Lepage
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Fanny Perez
- Cardiology Master 2, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Soleiman Alkhoder
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, Bichat Hospital, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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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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Retrospective analysis of single-center early and midterm results of transapical catheter-based mitral paravalvular leak closure with a purpose-specific device. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:167-175. [PMID: 30008769 PMCID: PMC6041841 DOI: 10.5114/aic.2018.76408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/11/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Due to the recent lack of definitions to establish the severity of paravalvular leak (PVL) and endpoints for its treatment, the effectiveness and safety of a new device for PVL closure have not been comprehensively analyzed. Aim To analyze a single center’s experience of mitral PVL closure in a surgical transapical catheter-based fashion with a purpose-specific device. Material and methods This is a retrospective cohort study of patients following transapical catheter-based mitral PVL closure with a purpose-specific device. Data were analyzed at baseline, perioperatively, at discharge, at six months and annually after the procedure. Results Nineteen patients underwent surgical transapical catheter-based mitral PVL closure with the Occlutech PLD Occluder. Mean follow-up time was 20 ±7 (range: 9–33) months. The patients’ mean age was 64 ±7 years, and 11 (58%) were male. Technical, device and individual patient success at follow-up was achieved in 18 (95%), 16 (84%) and 16 (84%) patients respectively. Median intensive therapy unit stay was one day (1–4) and mean hospital stay was 11 ±4 days. A reduction of paravalvular regurgitation to a mild or lesser degree was achieved in 18 (95%) patients. There were no strokes or myocardial infarctions at follow-up. There were no deaths at 30 days after the procedure. One (5%) patient expired due to progression of heart failure 12 months after surgery. None of the patients required immediate conversion to full sternotomy. Conclusions Surgical transapical catheter-based mitral PVL closure with the Occlutech PLD Occluder is a safe and clinically effective treatment.
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Hascoet S, Smolka G, Bagate F, Guihaire J, Potier A, Hadeed K, Lavie-Badie Y, Bouvaist H, Dauphin C, Bauer F, Nejjari M, Pillière R, Brochet E, Mangin L, Bonnet G, Ciobotaru V, Leurent G, Hammoudi N, Aminian A, Karsenty C, Spaulding C, Armero S, Collet F, Champagnac D, Ternacle J, Kloeckner M, Gerardin B, Isorni MA. Multimodality imaging guidance for percutaneous paravalvular leak closure: Insights from the multi-centre FFPP register. Arch Cardiovasc Dis 2018; 111:421-431. [DOI: 10.1016/j.acvd.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
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Dziubek M, Pierrakos C, Chebli L, Demanet H, Sanoussi A, Wauthy P. Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period. Curr Cardiol Rev 2018; 14:15-24. [PMID: 29141552 PMCID: PMC5872258 DOI: 10.2174/1573403x13666171110110344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Mitral para-prosthetic leaks are rare but major complications of mitral heart valve replacements. When they must be re-operated, they are burdened with high mortality rates. We proposed to review our surgical experience in terms of approach and type of operation carried out. Methods: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify the risk factors of postoperative mortality. We then compared the data depending on the approach and the type of surgical treatment in order to compare the morbidity-mortality. Results: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney failure were significantly more common in the decease population. Direct mitral paravalvular leak su-turing was more frequently performed on early apparition, anterior and isolated leaks, whereas a mi-tral heart valve replacement was most often performed to cure active primary endocarditis. The inci-dence of complications and mortality rates were identical according to the approach and the type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the cases. Conclusion: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered in those patients.
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Affiliation(s)
- Melvin Dziubek
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Charalampos Pierrakos
- Department of Intensive Care, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Louis Chebli
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Helene Demanet
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Ahmed Sanoussi
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Pierre Wauthy
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
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Banovic M, DaCosta M. Degenerative Mitral Stenosis: From Pathophysiology to Challenging Interventional Treatment. Curr Probl Cardiol 2018; 44:10-35. [PMID: 29731112 DOI: 10.1016/j.cpcardiol.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 01/01/2023]
Abstract
Mitral stenosis (MS) is characterized by obstruction of left ventricular inflow as a result of narrowing of the mitral valve orifice. Although its prevalence has declined over the last decade, especially in developed countries, it remains an important cause of morbidity and mortality. The most often cause of MS worldwide is still postrheumatic mitral valve disease. However, in developed countries, degenerative or calcific changes cause MS in a siginificant proportion of patients. Although the range of treatment for mitral valve disease has grown over the years in parallel with transcatheter therapies for aortic valve disease, these improvements in mitral valve disease therapy have experienced slower development. This is mainly due to the more complex anatomy of the mitral valve and entire mitral apparatus, and the interplay of the mitral valve with the left ventricle which hinders the development of effective implantable mitral valve devices. This is especially the case with degenerative MS where percutaneous or surgical comissurotomy is rarely employed due to the presence of extensive annular calcification and at the base of leaflets, without associated commissural fusion. However, the last few years have witnessed innovations in transcatheter interventional procedures for degenerative MS which consequently hinted that in the future, transcatheter mitral valve replacement could be the treatment of choice for these patients.
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Alkhouli M, Zack CJ, Sarraf M, Eleid MF, Cabalka AK, Reeder GS, Hagler DJ, Maalouf JF, Nkomo VT, Rihal CS. Successful Percutaneous Mitral Paravalvular Leak Closure Is Associated With Improved Midterm Survival. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005730. [DOI: 10.1161/circinterventions.117.005730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
Background—
Percutaneous closure of prosthetic mitral valve paravalvular leak (PVL) has emerged as an alternative to surgical treatment in high-risk patients. Limited data exist on the impact of successful percutaneous PVL closure on midterm outcomes.
Methods and Results—
We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31–7.25) years. One hundred sixty-two patients (70%) had ≤mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ≤mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%;
P
=0.004) and lower all-cause mortality at 30 days (1% versus 14%;
P
<0.001) and 1 year (15% versus 39%;
P
<0.001). Survival at 3 years was 61% in patients who had ≤mild residual leak and 47% in patients with higher grade of residual PVL (
P
=0.002).
Conclusions—
In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.
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Affiliation(s)
- Mohamad Alkhouli
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Chad J. Zack
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Mohammad Sarraf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Allison K. Cabalka
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Guy S. Reeder
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Donald J. Hagler
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Joseph F. Maalouf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
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Ruparelia N, Cao J, Newton JD, Wilson N, Daniels MJ, Ormerod OJ. Paravalvular leak closure under intracardiac echocardiographic guidance. Catheter Cardiovasc Interv 2017; 91:958-965. [PMID: 29024359 DOI: 10.1002/ccd.27318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/05/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of this study was to determine the safety and efficacy of intracardiac echocardiography (ICE) to guide percutaneous paravalvular leak (PVL) closure. BACKGROUND PVL following surgical valve replacement occurs in 2%-15% of patients. Percutaneous treatment is an accepted management strategy in patients deemed to be too high risk for redo surgery. This is most commonly performed with transesophageal (TOE) guidance requiring general anesthesia that both potentially further increase the risk of intervention. ICE can be used to guide intervention, facilitating procedures to be performed under local anesthesia without esophageal intubation potentially making procedures shorter and safer and further enabling the treatment of patients that may have been turned down for intervention. METHODS All patients that underwent ICE-guided percutaneous transcatheter PVL closure between 2006 and 2016 at the John Radcliffe Hospital, Oxford, United Kingdom were retrospectively analyzed. RESULTS Twenty-one procedures were performed in 18 patients during the study period. Fourteen patients (77.8%) underwent successful ICE guided PVL closure. There were no ICE-related complications. Eleven patients (78.6%) reported symptomatic improvement of at least one New York Heart Association (NYHA) Class and the remaining 3 patients had no change. No patient demonstrated objective evidence of persistent hemolysis following successful closure. There was one death within 30 days of the procedure and 1 year survival was 71.4%. CONCLUSIONS Percutaneous paravalvular leak closure guided by ICE without the requirement of general anesthesia is feasible, safe, and associated with acceptable procedural success rates.
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Affiliation(s)
- Neil Ruparelia
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Jacob Cao
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - James D Newton
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Neil Wilson
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.,Department of Paediatrics-Cardiology, Children's Hospital Colorado, Aurora, Colorado 80045
| | - Matthew J Daniels
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Oliver J Ormerod
- Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
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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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41
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Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks. JACC Cardiovasc Interv 2017; 10:1959-1969. [DOI: 10.1016/j.jcin.2017.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 11/21/2022]
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42
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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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43
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Minimally invasive left thoracotomy and prosthetic valve mini skirt for recurrent mitral paravalvular regurgitation. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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44
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Transcatheter and Surgical Management of Mitral Paravalvular Leak. JACC Cardiovasc Interv 2017; 10:1946-1956. [DOI: 10.1016/j.jcin.2017.07.046] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/16/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022]
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45
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Hilling-Smith R, Chong A, Cox S. Mitral paravalvular leak closure by antegrade percutaneous approach using amplatzer PFO closure device. Catheter Cardiovasc Interv 2017; 90:E62-E67. [PMID: 27084789 DOI: 10.1002/ccd.26417] [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: 01/06/2015] [Revised: 10/23/2015] [Accepted: 12/26/2015] [Indexed: 11/07/2022]
Abstract
Percutaneous closure of paravalvular leaks is becoming a more widely practiced technique. We describe the technique we used to deploy an Amplatzer PFO closure device to treat a prosthetic mitral paravalvular leak. The procedure was performed under real time 3D trans-oesophageal echo and fluoroscopic guidance requiring a trans-septal puncture and utilising an 035″ Safari wire which was developed for TAVR implantation. An excellent result was achieved acutely and at 4 month follow-up. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- R Hilling-Smith
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Chong
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - S Cox
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
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Said SM, Schaff HV, Greason KL, Pochettino A, Daly RC, Dearani JA. Reoperation for mitral paravalvular leak: a single-centre experience with 200 patients†. Interact Cardiovasc Thorac Surg 2017; 25:806-812. [DOI: 10.1093/icvts/ivx222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 05/14/2017] [Indexed: 11/13/2022] Open
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47
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van der Merwe J, Casselman F. Mitral Valve Replacement-Current and Future Perspectives. Open J Cardiovasc Surg 2017; 9:1179065217719023. [PMID: 28757798 PMCID: PMC5513524 DOI: 10.1177/1179065217719023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 06/13/2017] [Indexed: 11/20/2022] Open
Abstract
The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Various international databases report a significant decrease in replacement procedures performed compared with repairs, and contemporary guidelines limit the application of surgical mitral valve replacement to pathology in which durable repair is unlikely to be achieved. The progressive paradigm shift toward endoscopic and robotic mitral valve surgery is also paralleled by rapid developments in transcatheter devices, which is progressively expanding from experimental approaches to becoming clinical reality. This article outlines the current role and future perspectives of contemporary surgical mitral valve replacement within the context of mitral valve repair and the dynamic evolution of exciting transcatheter alternatives.
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Affiliation(s)
- Johan van der Merwe
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Filip Casselman
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
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Hassanin N, Sharaf Y, Ammar W, Sayed AYH. Early postoperative paravalvular leak among Egyptian population: An observational study. J Saudi Heart Assoc 2017; 29:160-168. [PMID: 28652669 PMCID: PMC5475341 DOI: 10.1016/j.jsha.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Several reports described the incidence of postoperative paravalvular leakage (PVL) early after valve replacement surgery, however, there is a paucity of data regarding the outcomes and complications correlated to the severity of PVL. The aim of the current study was to evaluate the incidence, causes, and short term outcome of early postoperative PVL. METHODS Data were collected from patients presenting to the cardiovascular department at Cairo University Hospital for aortic and/or mitral valve replacement surgery from May 2014 to May 2015. Transthoracic echocardiography (TTE) was done for all patients early postoperative. Transesophageal echocardiography (TEE) was done if diagnosis was not confirmed by TTE. All patients with detected PVL were subjected to TTE and TEE after a 3 month follow-up period. RESULTS Two hundred patients were enrolled in the study. Seventy five percent of patients were known to have rheumatic heart disease, while 16.5% had infective endocarditis. The mitral valve was replaced in 40% of patients, the aortic valve was replaced in 36%, and other patients had both valves replaced. Early postoperative period PVL was detected in 25 patients. The most common underlying etiologies were rheumatic heart disease and infective endocarditis. PVL was common in patients with both valves replaced compared with either mitral or aortic valve replacement. Infective endocarditis as underlying valve disease was significantly high in patients with PVL compared with those without (p < 0.001). CONCLUSION The incidence of PVL was high in patients with both valves replaced compared with either mitral or aortic valve replacement. Moreover, every patient with PVL should be properly investigated for infective endocarditis. Surgical intervention, although associated with high morbidity and mortality, reduces PVL recurrence.
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Affiliation(s)
- Noha Hassanin
- Cardiovascular Department, Cairo University, Cairo, 002020, EgyptEgypt
| | - Yasser Sharaf
- Cardiovascular Department, Cairo University, Cairo, 002020, EgyptEgypt
| | - Waleed Ammar
- Cardiovascular Department, Cairo University, Cairo, 002020, EgyptEgypt
| | - Amr Y H Sayed
- Cardiovascular Department, Cairo University, Cairo, 002020, EgyptEgypt
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Meadows S, Gordon P, Inman R. Mistaken identity: haemoglobinuria secondary to paravalvular leak masking as haematuria. BMJ Case Rep 2017. [PMID: 28630218 DOI: 10.1136/bcr-2016-218066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Haemolytic anaemia caused by a paravalvular leak presenting as progressively worsening red urine. Haemoglobinuria was easily mistaken for gross haematuria, resulting in extensive invasive urological investigation that proved to be futile. Further investigation following an emergency admission led to the realisation that intravascular haemolysis secondary to a paravalvular leakâ€"presenting 43 years following metallic valve insertionâ€"was the cause of discoloured urine and newly presenting symptomatic anaemia. This case highlights that there remains other causes of what often appears to be haematuria, and further exploration of alternative causes should be considered when no urological cause is found.
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Affiliation(s)
- Sam Meadows
- Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Patrick Gordon
- Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Richard Inman
- Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
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50
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Hernández-Enríquez M, Freixa X, Quintana E, Pereda D, Sandoval E, Sabaté M. Paravalvular Leak Correction: Searching for a Balance Between Surgical and Percutaneous Techniques. ACTA ACUST UNITED AC 2017; 71:679-681. [PMID: 28566244 DOI: 10.1016/j.rec.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Hernández-Enríquez
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Freixa
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Eduard Quintana
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Pereda
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Sandoval
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manel Sabaté
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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