Percutaneous transcatheter closure of prosthetic paravalvular leaks

Background: Paravalvular leaks (PVLs) are among the most common complications of surgical valve replacement. However, improvements in interventional radiology allow alternative strategies for their treatment. This study evaluated percutaneous transcatheter closure of PVLs in 13 patients (10 male, 3 female). Methods: The location, shape, and size of the PVL were first identified by fluoroscopy, transesophageal echocardiography (TEE), and transthoracic echocardiography (TTE); we then selected the appropriate device. Thirty days after the procedure, heart morphology and function were assessed by TTE. Vital status and adverse events of all patients were regularly assessed. Results: Percutaneous transcatheter closure of prosthetic PVL was a technical success in 12 patients. The only major adverse event occurred in one patient whose sudden death we consider unrelated to the surgery. Left ventricular end-diastolic diameter (LVED) and pulmonary artery pressure (PAP) were decreased significantly compared with pre-operation echocardiographic assessment (from 62.9±16.2 to 59.2±16.1 mm, and from 41.5±10.2 to 34.9±8.9 mmHg). New York Heart Association functional class was improved by at least one grade in five patients. No patient required blood transfusion after the procedure. The patient survival rate after PVL closure was 83%. Another death occurred 13 months after surgery because of progressive heart failure. There was no bioprosthetic or autologous valve erosion, and no hemolysis, thromboembolic events, or cardiac blocking. Conclusions: Our experience suggests that percutaneous transcatheter closure of PVL is feasible and safe with careful anatomic analysis of the PVL and selection of appropriate patients and devices.