Percutaneous repair of paravalvular prosthetic regurgitation: patient selection, techniques and outcomes

Abstract

Paravalvular prosthetic regurgitation is common, affecting 5-10% of surgical prostheses and 40-70% of transcatheter valves. While many patients may suffer no significant morbidity, paravalvular prosthetic regurgitation can lead to heart failure and haemolytic anaemia, and, in some studies, has been associated with impaired survival. Over the past several years, percutaneous repair of paravalvular prosthetic regurgitation has been demonstrated to be a highly efficacious therapy. When performed in experienced centres, procedural success with percutaneous repair occurs in 90% of patients. Due to the complex nature of the techniques, there is a significant learning curve with a high potential for prolonged procedures (∼2.5 h) and complications (∼5%), although death is rare (∼0.5%). Percutaneous repair of paravalvular prosthetic regurgitation requires a close collaboration between imaging specialists, surgeons and the interventional operators. Importantly, successful percutaneous repair obviates the need for open surgical correction, which can be high risk or prohibitive due to the need for reoperation in the setting of comorbidities. Herein, we discuss appropriate patient selection, the catheter-based techniques and outcomes of percutaneous repair for symptomatic paravalvular prosthetic regurgitation.

Percutaneous Valvular Closure Followed by TAV-in-TAV Intervention during a Single Procedure in order to Treat a Severe Paravalvular Leak after Performing TAVI in a Bicuspid Aortic Stenosis

“…This particular morphology together with the eccentric geometry of the aortic root increases the risk of uneven expansion of the valve. Despite the fact that percutaneous valvular closure using either Amplatzer plugs [10, 11] or TAV-in-TAV procedures [12, 13] is well described in the literature as reasonable strategies, to the best of our knowledge, this is the first case where both interventions were performed during a single procedure to minimise a severe PVL.…”

“…However, fluoroscopy and TEE showed no improvement to the PVL (Supplementary 1). Among the possible strategies, percutaneous valvular closure using Amplatzer plugs constitutes a viable alternative in patients developing a PVL after TAVI [10, 11]. After an urgent discussion, the heart team decided to proceed with paravalvular implantation of a cardiac plug in an attempt to seal the PVL and improve the patient's haemodynamic status.…”

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

“…El tratamiento médico, que incluye suplementos de hierro, bloqueadores beta y eritropoyetina, está indicado para pacientes con anemia hemolítica grave que tengan contraindicada la cirugía. El cierre percutáneo de una fuga paravalvular es factible, pero la experiencia es escasa y por el momento no hay pruebas concluyentes que demuestren su eficacia 204 .…”

Native and Prosthetic Valve Emergencies

“…36.37 Survival at 18 months after closure has been reported to be 86% in 1 series, and 3-year survival was 64% in another. 38,39 The treatment of mechanical prosthetic thrombosis has been altered somewhat over the years as a result of emerging, but relatively spotty data surrounding the use of thrombolytic agents. The largest series comprised 110 consecutive patients at a single center that presented over a 23-year period before 2001.…”