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Gérardin B, Hascoët S, Andarelli JN, Batteux C, Albenque G, Kloeckner M, Blanchard D, Brenot P. [How I deal with this unusual paravalvular leak]. Ann Cardiol Angeiol (Paris) 2024; 73:101790. [PMID: 39121668 DOI: 10.1016/j.ancard.2024.101790] [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: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 08/12/2024]
Abstract
Percutaneous treatment of para-prosthetic valve leaks (PVL) is an alternative to redo surgery. Based on the clinical case of an unusual aortic para-prosthetic leak closure (PVLc), are presented successively the diagnostic difficulties of PVL, the modalities of therapeutic choice, the main technical steps of PVLc followed by a review of results and complications.
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Affiliation(s)
- B Gérardin
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France.
| | - S Hascoët
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - J N Andarelli
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - C Batteux
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - G Albenque
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - M Kloeckner
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - D Blanchard
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - P Brenot
- Hôpital Marie Lannelongue. 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France
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Flores-Umanzor E, Cepas-Guillén P, Ruberti A, Regueiro A, Sanchis L, Gabani R, Rodés-Cabau J, Vidal B, Freixa X. Paravalvular leak closure after TAVI with plugs: A literature review with a specific focus on arterio-arterial loop. Catheter Cardiovasc Interv 2024. [PMID: 38984656 DOI: 10.1002/ccd.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
More than mild paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) is associated with a twofold increase in all-cause mortality, heart failure hospitalizations, and the need for reintervention. Successfully addressing PVL in TAVIs is more challenging than in surgical valves. The arterial-arterial (A-A) rail technique emerges as a valuable strategy for post-TAVI PVL closure, enhancing success rates by enabling the effective use of lower-profile vascular plug devices. When standard approach is ineffective, generating an A-A loop for post-TAVI PVL closure is probably the most recommended strategy to ensure procedural success.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Cepas-Guillén
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Andrea Ruberti
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ander Regueiro
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Sanchis
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rami Gabani
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Rodés-Cabau
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Barbara Vidal
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
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3
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Har BJ. Defining Success of Transcatheter Device Closure for Mitral Paravalvular Leak: Why It's Important. Can J Cardiol 2024; 40:1223-1225. [PMID: 38579963 DOI: 10.1016/j.cjca.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Bryan J Har
- Libin Cardiovascular Institute and Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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4
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Belahnech Y, Aguasca GM, García Del Blanco B, Ródenas-Alesina E, González Alujas T, Gutiérrez García-Moreno L, Galian-Gay L, Fernández-Galera R, Irurueta IO, Serra V, Bellera N, Serra B, Calabuig A, Barceló MC, Barrabés JA, Ferreira González I. Impact of a Successful Percutaneous Mitral Paravalvular Leak Closure on Long-term Major Clinical Outcomes. Can J Cardiol 2024; 40:1213-1222. [PMID: 38013065 DOI: 10.1016/j.cjca.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Percutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the impact of successful percutaneous mitral PVL closure on long-term outcomes. METHODS All consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary centre between January 2010 and October 2021 were included. Clinical variables, procedural details, and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFHs) were key secondary endpoints. RESULTS Ninety patients (median age 72.5 years [66.0-78.4]; median EuroSCORE-II 8.2 [5.3-12.46]) were included. Although reduction of at least 1 degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared with the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [CI], 1.41-4.78), cardiovascular death (aHR, 3.53; 95% CI, 1.67-7.49) and HFH (aHR, 3.27; 95% CI,1.72-6.20). CONCLUSIONS A successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death, and HFHs.
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Affiliation(s)
- Yassin Belahnech
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Martí Aguasca
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Bruno García Del Blanco
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa González Alujas
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Gutiérrez García-Moreno
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Galian-Gay
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Rubén Fernández-Galera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Imanol Otaegui Irurueta
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Viçens Serra
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Neus Bellera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Serra
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Calabuig
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Calvo Barceló
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José A Barrabés
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Ferreira González
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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5
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Flores-Umanzor E, Nogic J, Cepas-Guillén P, Hascoet S, Pysz P, Baz JA, Cruz-González I, Amat-Santos IJ, Antúnez-Muiños P, González JC, Ruíz-Quevedo V, Estevez-Loureiro R, Gerardin B, Millan X, Santaló-Corcoy M, Regueiro A, Ibrahim R, Arzamendi D, Onorato EM, Rodés-Cabau J, Horlick E, Calvert PA, Freixa X. Percutaneous paravalvular leak closure after transcatheter aortic valve implantation: the international PLUGinTAVI Registry. EUROINTERVENTION 2023; 19:e442-e449. [PMID: 37128805 PMCID: PMC10397666 DOI: 10.4244/eij-d-22-01110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Data regarding the safety and long-term effectiveness of percutaneous closure of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) are scarce. AIMS This study aims to present a large multicentre international experience of percutaneous post-TAVI PVL closure. METHODS All patients who underwent percutaneous post-TAVI PVL closure in 14 hospitals across Europe and North America between January 2018 and October 2022 were included. RESULTS Overall, 45 patients (64% male) were enrolled. The median age was 80 years (75-84). Among them, 67% and 33% had self-expanding and balloon-expandable valve implantations, respectively. Baseline post-TAVI PVL was severe in 67% of cases and moderate in the rest. The time from index TAVI to PVL closure procedure was 16.1 (8.7-34.8) months. Most patients were in NYHA Class III and IV (73%) before the procedure, and 40% had referred hospitalisations for heart failure between TAVI and the PVL closure procedure. Successful PVL closure was achieved in 94%, reducing regurgitation to ≤mild in 91% and moderate in the rest. The Amplatzer Valvular Plug III was the most frequently used device (27 cases), followed by the Amplatzer Valvular Plug 4. The incidence of severe adverse events was 11%. None of the patients died during the index hospitalisation. During long-term follow-up (21.7±16.2 months), the all-cause mortality rate was 14%, and patients presented improvement in functional status and a significant reduction in the rate of hospitalisation for heart failure (from 40% to 6%). CONCLUSIONS Percutaneous PVL closure is a feasible and safe option for treating post-TAVI leaks. Successful PVL reduction to mild or less could be associated with acute and long-lasting improvements in clinical outcomes.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), Toronto, ON, Canada
| | - Jason Nogic
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Pedro Cepas-Guillén
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | - Sebastian Hascoet
- Department of Congenital Heart Diseases, Marie Lannelongue Hospital, M3C Network, INSERM UMR-S 999, Paris-Saclay University, Plessis-Robinson, Paris, France
| | - Piotr Pysz
- Medical University of Silesia, Katowice, Poland
| | - Jose Antonio Baz
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | | | - Ignacio J Amat-Santos
- Hospital Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | | | - Rodrigo Estevez-Loureiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Benoit Gerardin
- Department of Congenital Heart Diseases, Marie Lannelongue Hospital, M3C Network, INSERM UMR-S 999, Paris-Saclay University, Plessis-Robinson, Paris, France
| | | | | | - Ander Regueiro
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
| | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), Toronto, ON, Canada
| | | | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Barcelona, Spain
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6
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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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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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8
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Freixa X, Gabani R, Cepas-Guillén P, Flores-Umanzor E, Estévez-Loureiro R, Onorato EM. Paravalvular Leakages after Surgical Aortic-Valve Replacement and after Transcatheter Aortic-Valve Implantation: Strategies to Increase the Success Rate of Percutaneous Closure. J Clin Med 2022; 11:jcm11112989. [PMID: 35683375 PMCID: PMC9181351 DOI: 10.3390/jcm11112989] [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: 04/28/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Moderate to severe paravalvular-leak (PVL) regurgitation after surgical aortic-valve replacement or after transcatheter valve implantation represents a well-known complication associated with symptoms related to heart failure, hemolysis, or both in patients with multiple comorbidities and with poor prognostic outcomes. The transcatheter closure of aortic paravalvular leaks (APVLs) is currently considered a valid alternative to cardiac surgery. Nevertheless, careful patient selection, optimal cardiac imaging for intraprocedural guidance, and expert operators are key for success. Although technically demanding, particularly in APVLs after transcatheter valve implantation, catheter-based closure is an effective, less invasive, and often the only option for high-risk patients with symptomatic PVL regurgitation.
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Affiliation(s)
- Xavier Freixa
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Rami Gabani
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Pedro Cepas-Guillén
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | - Eduardo Flores-Umanzor
- Interventional Cardiology Department, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, Spain; (X.F.); (R.G.); (P.C.-G.); (E.F.-U.)
| | | | - Eustaquio Maria Onorato
- Interventional Cardiology Department, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy
- Correspondence:
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