Author + information
- Vasilis Babaliaros1,
- Murad Abdelsalam2,
- Sameer Gafoor1,
- James stewart1,
- Vinod Thourani1 and
- Peter Block1
Percutaneous transcatheter closure of Paravalvular leaks is a new alternative approach to re-do surgery, which is associated with considerable mortality and morbidity. We aim to evaluate feasibility and short term results with this novel closure technique.
Between May 2007 and September 2011. 16 symptomatic patients (seven males, nine females; mean age 59.1 ± 17.9 years) with heart failure (n=9 ), hemolytic anemia (n=2) or both (n=5) underwent percutaneous PVL closure at our center. Most patients were high risk for open surgical repair (STS score 7.64 ± 8.02) with average number of sternotomies equal to 2.3 (range 0-4). Both left and right sided valves were intervened upon including Mitral valves (n=10), Aortic valves (n=5), one of which was a trans-catheter placed Sapien Valve, Pulmonic valves ( n=1). The procedure was done under echocardiographic and fluoroscopic guidance using the Amplatzer Septal Occluder, Duct Occluder or Vascular Plug II.
Successful percutaneous repair was achieved in 12 out of 16 patients (75%). Failure to cross the leak with either the wire or the catheter occurred in two patients. In the other two patients, device was deployed with residual moderate regurgitation. There were no procedural or unexplained death, but there were two post procedural deaths, one patient had severe septic shock and the other had cardiogenic shock prior to intervention. No emergency surgery or device embolization occurred .One patient had an ischemic stroke in the fifth post-operative day. One patient with multiple defects and a failed attempt required an elective surgical repair to seal the leak.
Percutaneous transcatheter closure of paravalvular leaks is feasible but appears to be technically demanding procedure with acceptable success rate especially in poor surgical candidate. Further experience is warranted to evaluate long term morbidity and mortality.
- 2013 American College of Cardiology Foundation