Closure of prosthetic paravalvular mitral regurgitation with the Gianturco‐Grifka vascular occlusion device

Eisenhauer, Andrew C.; Piemonte, Thomas C.; Watson, Paul S.

doi:10.1002/ccd.1274

Cited by 43 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, surgery may not be successful since the original anatomical problems persist. Because of these issues, there is tremendous interest in minimally invasive percutaneous techniques that may allow successful treatment of paravalvular regurgitation without another sternotomy (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Principles Of Percutaneous Paravalvular Leak Closurementioning

confidence: 99%

Principles of Percutaneous Paravalvular Leak Closure

Rihal

Sorajja

Booker

et al. 2012

JACC: Cardiovascular Interventions

158

106

View full text Add to dashboard Cite

Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. For paramitral defects, an antegrade transseptal approach can usually be guided by biplane fluoroscopy, and real-time 3-dimensional transesophageal echocardiography can usually be performed successfully. Alternative approaches to paramitral defects include retrograde transaortic cannulation or transapical access and retrograde cannulation. For oblong or crescentic defects, the simultaneous or sequential deployment of 2 smaller devices, as opposed to 1 large device, results in a higher degree of procedural success and safety because the risk of impingement on the prosthetic leaflets is minimized. Most para-aortic defects can be approached in a retrograde manner and closed with a single device. With careful anatomical assessment, procedural planning, and procedural execution, successful closure rates of 90% or more should be attainable with a low risk of device impingement on the prosthetic valve or embolization.

show abstract

Section: Principles Of Percutaneous Paravalvular Leak Closurementioning

confidence: 99%

Principles of Percutaneous Paravalvular Leak Closure

Rihal

Sorajja

Booker

et al. 2012

JACC: Cardiovascular Interventions

158

106

View full text Add to dashboard Cite

show abstract

“…As a result, off-label use of other available devices remains the only percutaneous therapeutic option (Table 2), though this option should be considered only after the patient has been comprehensively informed of the potential risks and benefits of off-label device use. Although various devices including umbrella devices (7), vascular occluding devices (20), and coils (19), have been used, the Amplatzer family of devices (AGA Medical Inc., Plymouth, Minnesota) has gained popularity as the most frequently employed devices for PVL closure (8,16,17), and further discussion will be limited to this group of devices. A careful examination of the PVL anatomy, the relationship of the defect to surrounding structures, and the planned procedural approach, so that the device with the most appropriate characteristics is chosen, is critical to procedural and clinical success.…”

Section: Choice Of Pvl Closure Devicementioning

confidence: 99%

Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks

Kim

Casserly

Garcia

et al. 2009

JACC: Cardiovascular Interventions

109

View full text Add to dashboard Cite

A potential complication of mitral valve replacement surgery is the development of a paravalvular leak (PVL). Percutaneous transcatheter closures of PVLs using a wide array of devices have been reported in the literature, although the procedural success rate of this approach remains variable. One major challenge of transcatheter mitral PVL closure lies in the ability to adequately visualize the area of interest to facilitate defect crossing and equipment selection. Furthermore, the current spectrum of devices available for off-label use in the closure of these unique defects remains limited. This review examines the current state of transcatheter prosthetic mitral PVL closure, describes our institution's experience using advanced imaging modalities for procedural guidance, and illustrates some of the limitations associated with using existing devices in transcatheter PVL closure.

show abstract

“…41 Some individual case reports noted a favorable effect of transcatheter treatment on hemolysis, 43,44 whereas others did not. 45,46 Because the current devices can hardly fit into the shape of the leaking area, there may be a certain degree of residual regurgitation, leading to postprocedural hemolysis that is even worse than the preprocedural one. Furthermore, the risk of certain procedure-specific complications should be borne in mind, including impingement on leaflet motion, worsening of leakage due to radial forces, device embolization, and damage to the valve.…”

Section: Percutaneous Closurementioning

confidence: 99%

Hemolysis Associated With Prosthetic Heart Valves

Shapira¹,

Vaturi²,

Sagie³

2009

Cardiology in Review

View full text Add to dashboard Cite

Hemolysis is one of the potentially serious complications of prosthetic heart valves. It is usually associated with either structural deterioration or paravalvular leak. Mild, compensated hemolysis associated with mechanical heart valves is not uncommon even in the current era. Severe hemolysis is rare, however, and usually reflects paravalvular leak. The use of transesophageal echocardiography-guided operative techniques may help prevent or minimize early postoperative paravalvular leakage. There is a gamut of available therapeutic approaches-medical, transcatheter, and surgical-to this complication and therapy should be tailored to the individual patient. Novel pharmacological agents include erythropoietin and pentoxifylline. Several reports described the feasibility of transcatheter closure of paravalvular leak with coils or devices, but their effect on hemolysis is unpredictable. Surgery remains the treatment of choice in severe cases.

show abstract

Closure of prosthetic paravalvular mitral regurgitation with the Gianturco‐Grifka vascular occlusion device

Cited by 43 publications

References 18 publications

Principles of Percutaneous Paravalvular Leak Closure

Principles of Percutaneous Paravalvular Leak Closure

Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks

Hemolysis Associated With Prosthetic Heart Valves

Contact Info

Product

Resources

About