Interventional treatment of paravalvular regurgitation by plug implantation following prosthetic valve replacement: a single-center experience

Werner, Nicolas; Zeymer, Uwe; Fraiture, Boris; Kilkowski, Caroline; Riedmaier, Patrick; Schneider, Steffen; Zahn, Ralf

doi:10.1007/s00392-018-1290-7

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…We can close most PVLs (width <10 mm, and length of <15 mm) via the brachial artery approach. Several previous studies have reported that the clinical success rate of transcatheter closure of PVL ranged from 69.5 to 93% (13)(14)(15). In our study, nine patients achieved clinical improvement.…”

Section: Discussionsupporting

confidence: 52%

Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement

Zhang

Wang

et al. 2021

Front. Cardiovasc. Med.

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Background: Transcatheter closure of paravalvular leak (PVL) has evolved into an alternative to surgery in high-risk patients. In this study, we introduce a new access for transcatheter closure of PVL and seek to evaluate the feasibility and safety of this access.Methods: We retrospectively analyzed patients undergoing transbrachial access for transcatheter mitral or aortic PVL closure (August 2017–November 2019) at our hospital. All patients underwent puncture of the brachial artery under local anesthesia.Results: The study population included 11 patients, with an average age of 55.91 ± 14.82 years. Ten out of 11 patients were successfully implanted with devices via the brachial artery approach, and one patient was converted to the transseptal approach. The technical success rate of transbrachial access was 90.9%. Mean NYHA functional class improved from 3.1 ± 0.5 before the procedure to 1.9 ± 0.5 after PVL closure. Severe paravalvular regurgitation (PVR) in five patients and moderate PVR in six patients prior to the procedure were significantly reduced to mild in four patients and none in seven patients after the procedure. Complications included one case of pseudoaneurysm and one case of moderate hemolysis aggravation after closure. One patient had an unknown cause of sudden death within 24 h after the procedure. The half-year mortality rate during follow-up was 9.1% (1/11).Conclusions: Transbrachial access for transcatheter closure of PVL may be a feasible and safe treatment and should include well-selected patients. It has several potential advantages of simplifying the procedure process and reducing postprocedural bed rest time.

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Section: Discussionsupporting

confidence: 52%

Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement

Zhang

Wang

et al. 2021

Front. Cardiovasc. Med.

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“…While a number of devices have European approval, there are currently no occluder devices approved by the United States Food and Drug Administration specifically to treat PVR 19 . The majority of data surrounding these self‐expanding occluder devices are from procedures treating a focal jet of PVR and have shown a high degree of success (>85%) and minimal rates (3.8%‐10%) of procedural complications 9,10,13,14,20‐22 . Devices available include the Amplatzer vascular occluders, Amplatzer duct occluders, Amplatzer septal occluders, and Occlutech Paravalvular Leak Devices, with selection of specific device tailored to the patient (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Valve‐in‐valve transcatheter aortic valve replacement to treat multijet paravalvular regurgitation: A case series and review

Randall

Lewandowski

Choi

et al. 2020

Clinical Cardiology

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Treatment advances for severe symptomatic aortic stenosis including transcatheter and open surgical valve replacement have improved patient survival, length of stay, and speed to recovery. However, paravalvular regurgitation (PVR) is occasionally seen and when moderate or greater in severity is associated with an at least 2‐fold increase in 1 year mortality. While several treatment approaches focused on single‐jet PVR have been described in the literature, few reports describe multijet PVR. Multijet PVR can successfully be treated with a variety of catheter‐based options including valve‐in‐valve (ViV) transcatheter aortic valve replacement (TAVR). We present two patients with at least moderate PVR following aortic valve replacement who were successfully treated with ViV TAVR along with a review of literature highlighting our rationale for utilizing each management approach. Multijet PVR can be treated successfully with ViV TAVR, but additional options such as self‐expanding occluder devices and bioprosthetic valve fracture have a role as adjunctive treatments to achieve optimal results. The etiology of multijet PVR can differ between patients, this heterogeneity underscores the paucity of data to guide treatment strategies. Therefore, successful treatment of multijet PVR requires familiarity with available therapeutic options to achieve optimal results and, by extension, decrease patient mortality.

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“…In comparison with CT and cardiac MRI, TEE is invasive and associated with an approximately 0.9% risk of complications such as esophageal perforation, bleeding, sedation-related events, arrhythmia, and even death. 10,11 For patients unable to undergo TEE due to swallowing difficulties or other gastrointestinal problems, cardiac MRI and CT represent viable options for ruling out LAA thrombus prior to ablation. In contrast, TEE is portable and does not use iodinated or gadolinium contrast agents.…”

Section: Preprocedural Imagingmentioning

confidence: 99%

Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes?

Obeng-Gyimah

Nazarian

2020

J Innov Cardiac Rhythm Manage.

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Since the introduction of atrial fibrillation (AF) ablation in the 1990s, the procedure has continuously evolved, with gradual improvements in outcomes and safety. Recent technological advancements include the introduction of contact force catheters and high-resolution electroanatomical mapping systems, while imaging modalities including transesophageal echocardiography and fluoroscopy have become integral parts of AF ablation procedures. Further, intraprocedural intracardiac echocardiography and the integration of cardiac magnetic resonance and computed tomography images with electroanatomical mapping have shown promise to improve procedural outcomes by reducing radiation exposure and procedural times. However, available data on procedural utility and the reduction in AF recurrence rates associated with these modalities are mixed. This review therefore aims to discuss the current common imaging modalities used in AF ablation and their potential impact on outcomes. In particular, imaging is discussed with respect to the important information it offers before, during, and after the procedure. Perspectives on the future of imaging in AF ablation are also shared.

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Interventional treatment of paravalvular regurgitation by plug implantation following prosthetic valve replacement: a single-center experience

Cited by 11 publications

References 27 publications

Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement

Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement

Valve‐in‐valve transcatheter aortic valve replacement to treat multijet paravalvular regurgitation: A case series and review

Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes?

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