Percutaneous paravalvular leak closure: chasing the chameleon

Abstract

Paravalvular leak (PVL) occurs after both surgical and transcatheter valve replacement/implantation. It can lead to haemolysis, heart failure and may increase the risk of endocarditis. Percutaneous closure has significantly less morbidity than re-operation and is therefore often the therapy of choice. Percutaneous PVL closure can make an important difference for patients and can improve patient prognosis. These procedures can be intricate and larger case series and research is needed to further develop and improve these procedures.--

Surgical vs. Percutaneous Approaches to Paravalvular Leak: Is Closure Too Little Too Late, or Just Not Soon Enough

“…The survival free from the composite end‐point of death and readmissions according to the treatment received showed no significant differences during the first year. Other series of patients treated percutaneously have also showed poor long‐term prognosis . This study confirms these data, showing that nearly half of the patients are dead after ∼2.5 years with either surgical or percutaneous PVL closure.…”

Cardioscopically Guided Beating Heart Surgery: Paravalvular Leak Repair

“…The scalable design can be adapted for transfemoral access, which is often preferred for PVL closure [1,2]. Furthermore, the direct visualization during occluder delivery provided by cardioscopy may be equally applicable to the deployment of many valve replacement and repair devices.…”

“…PVL is a complication that can occur after both surgical and transcatheter prosthetic valve implantation. Their repair usually involves delivering one or more occluders into the leak to reduce or eliminate regurgitant flow [1]. Occluder deployment inside PVLs is currently performed using combinations of CT angiography, fluoroscopy and transesophageal echocardiography and requires an experienced interdisciplinary team of cardiovascular interventionalists and imaging experts [1,2].…”

“…Their repair usually involves delivering one or more occluders into the leak to reduce or eliminate regurgitant flow [1]. Occluder deployment inside PVLs is currently performed using combinations of CT angiography, fluoroscopy and transesophageal echocardiography and requires an experienced interdisciplinary team of cardiovascular interventionalists and imaging experts [1,2]. Direct imaging of the valve annulus could substantially improve procedural success and reduce interventional time if it enables leak localization, visualization during deployment and evaluation of potential interference with valve function.…”

Three‐dimensional echocardiography in the evaluation and management of paravalvular regurgitation

“…Mild PVR is usually asymptomatic with minimal clinical sequelae and therefore typically requires no treatment . However, moderate and severe PVR can lead to heart failure, hemolytic anemia, or both, and therefore intervention is often needed . Prior to the first report of percutaneous closure of aortic PVR using a Rashkind umbrella in 1992 by Hourihan et al, redo surgery was the standard of care for the management of PVR.…”