Effect of percutaneous paravalvular leak closure on hemolysis

Abstract

Objective To study the effect of percutaneous paravalvular leak closure on hemolysis. Background Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with paravalvular leaks (PVL), little is known about its effect on hemolysis. Methods We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005–December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis. Results Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044). Conclusion Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves.

Treating hemolysis due to perivalvular leaks: It is all about modifying micro‐jets and not the volume of regurgitation

“…The results of Panaich et al, are consistent with the concept of micro‐shear forces etiology for valve‐induced hemolysis. Closure of leaks around mechanical valves rather than biologic valves was much more likely to result in a hematological success, and the more leaks plugged, the better, would fit nicely with reducing or modifying the high‐energy jets and the microenvironment conducive for hemolysis.…”

“…Dr. Panaich, and colleagues from the Mayo Clinic, have reviewed their experience with paravalvular leak closure and its association with subsequent hemolysis. They retrospectively, over a decade of experience, found 168 patients who underwent percutaneous closure and had significant evidence of hemolytic anemia before the procedure.…”

Cardiac prostheses‐related hemolytic anemia

“…For example, Ruiz et al reported a substantial decrease in the percentage of patients who required blood transfusion or erythropoietin injections after percutaneous PVL repair from 56% to 5% . On the contrary, in another study of 168 patients with PVL, blood transfusion requirements decreased only modestly after percutaneous repair from 34% to 21% . These inconsistencies may be related to the variable definitions of hemolysis and the degree of PVL reduction achieved.…”

A new technique of managing paravalvular leak using a folding pericardium patch

“…PVL is a common complication during surgical valve replacement and has been reported in 2% to 10% of aortic valve replacements (AVR) and 7% to 17% of mitral valve replacements (MVR) . Cardiac surgeons have been searching for an effective way to tackle PVLs for a long time.…”

“…Paravalvular leakage (PVL) is one of the most well‐recognised complications of prosthetic valve replacement. It is quite common and can be seen in 2% to 10% of replacements in the aortic position . However, no unified standard procedure for managing this complication exists.…”