Paravalvular regurgitation after conventional aortic and mitral valve replacement: A benchmark for alternative approaches

Abstract

In an academic medical center, the overall rate of paravalvular regurgitation is low, and late clinically significant noninfectious paravalvular regurgitation is rare. The benchmark for paravalvular regurgitation after conventional valve replacement is high and should be considered when evaluating patients for transcatheter or sutureless valve replacement.

Percutaneous paravalvular leak closure: chasing the chameleon

“…16 The incidence of relevant PVL after valve surgery is reported to be 1% in aortic and 2.2.% in mitral cases. 17 After 11 years of follow-up, the incidence of aortic PVL was increased to 4% (mechanical valve) and 2% (bioprosthetic valve), whereas mitral PVL increased to 17% (mechanical valve) and 9% (bioprosthetic valve). 16 While aortic PVL are typically less complex to close, percutaneous closure of mitral PVL's can be technically intricate.…”

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

“…[143][144][145]160 In general, patients with mechanical valve replacement experience a higher risk of bleeding due to anticoagulation, whereas individuals who receive a bioprosthetic valve replacement experience a higher rate of reoperation due to structural deterioration of the prosthesis and perhaps a decrease in survival. 142,143,[145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160]162 Stroke rate appears to be similar in patients undergoing either mechanical or bioprosthetic AVR, but it is higher with mechanical than with bioprosthetic MVR. [142][143][144][145]157 There are several other factors to consider in the choice of type of valve prosthesis (Table 3).…”

“…Ultimately, the choice of mechanical versus bioprosthetic valve replacement for all patients, but especially for those between 50 and 70 years of age, is a shared decision-making process that must account for the trade-offs between durability (and the need for reintervention), bleeding, and thromboembolism. 143,[145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160]162 IIa B A bioprosthesis is reasonable for patients more than 70 years of age. [163][164][165][166] 2014 recommendation remains current.…”

Percutaneous Closure of Paravalvular Leak from a Rocking Mitral Valve in a 74-Year-Old Man at High Surgical Risk

“…This complication occurs in nearly 3% of surgical mitral valve replacements, most often in cases involving endocarditis. 1 Moderate-to-severe PVL after surgical or transcatheter valve replacement can raise mortality rates. 2 Percutaneous PVL closure, which is less invasive than surgical repair, has resulted in less morbidity and similar outcomes.…”