Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement

Waterbury, Thomas M.; Reeder, Guy S.; Pislaru, Sorin V.; Cabalka, Allison K.; Rihal, Charanjit S.; Eleid, Mackram F.

doi:10.1002/ccd.27224

Cited by 32 publications

(20 citation statements)

References 17 publications

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“…Tandar et al presented significant correction of PVL with ViV with near complete resolution of moderate PVL [43]. Treatment of PVL with a second valve ViV is an alternate therapy that may be required if the PVL is due to an incorrect implant depth, too high or low, relative to the annulus [14,44]. The occurrence of PVL due to lack of adequate coverage of the valve annulus necessitates ViV implantation.…”

Section: Valve-in-valvementioning

confidence: 99%

Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

et al. 2020

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Purpose of Review With increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL. Recent Findings Despite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking. Summary Although the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical intervention in select patients after previous surgical or percutaneous valve replacement. PVL treatment with vascular plugs, balloon post-dilation, and the valve-in-valve methods have shown technical success with promising clinical outcomes in appropriately selected patients.

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Section: Valve-in-valvementioning

confidence: 99%

Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

et al. 2020

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“…First, it is critical to delineate the mechanism of post-TAVR PVL prior to attempting closure; PVL due to the device being too high or too low in position may not be effectively treated with PVL closure and may require valve-in-valve instead. Additionally, post-TAVR PVL due to an undersized or underexpanded prosthesis may be treatable with balloon postdilatation, especially in the case of multiple circumferential leaks around a balloon-expandable valve 14. In general, paravalvular leaks associated with TAVR are often smaller and more serpiginous compared with surgical valves and may only be crossable with smaller catheters as opposed to coronary guide catheters and shuttle sheaths.…”

Section: Aortic Pvl Closurementioning

confidence: 99%

“…Repeat PVL closure is most commonly required due to the development of new defects and has a similar success rate compared with first time procedures 18. PVL closure after TAVR can also be performed with a similar success rate compared with with surgical aortic prostheses 14. The effectiveness of PVL closure as a treatment for haemolysis is less well understood.…”

Section: Outcomes and Future Directionsmentioning

confidence: 99%

Interventional management of paravalvular leak

Eleid

2018

Heart

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“…Generally, post‐TAVR PVR is managed by either balloon post‐dilation or valve‐in‐valve implantation. In selected cases of post‐TAVR PVR, percutaneous closure can be successfully performed . Although TEE and fluoroscopy are the main modalities used for intra‐procedural monitoring and guidance, both TTE and intracardiac echo have been successfully utilized in anteriorly located aortic PVR …”

Section: Aortic Valvementioning

confidence: 99%

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

et al. 2018

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Paravalvular regurgitation is an uncommon but serious complication that can be encountered after either surgical or percutaneous valve replacement and is associated with increased morbidity and mortality. Early detection and accurate assessment of paravalvular regurgitation are crucial to identify those who would benefit from intervention. Recent advances in 3‐dimensional echocardiography have increased the feasibility of percutaneous approaches for the management of paravalvular regurgitation. Percutaneous closure of paravalvular regurgitation has emerged as a favorable alternative for redo surgery in selected cases. This article will review the role of 3‐dimensional echocardiography in the assessment and management of paravalvular regurgitation.

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Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement

Abstract: In selected patients, percutaneous PVL repair following TAVR is feasible and effective for both balloon-expandable and self-expanding prostheses. Most patients undergoing PVL closure after TAVR require a single occluder plug placement for reduction in PVL to mild or less.

Cited by 32 publications

References 17 publications

Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches

Interventional management of paravalvular leak

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

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