Clinical and Procedural Characteristics and Outcomes of Catheter-Based Intervention for Clinically Significant Paravalvular Leak

Introduction: Clinically significant paravalvular leak (PVL) occurs in 2-5% of the patients undergoing valve replacement surgery. Little is known regarding the outcomes of percutaneous PVL closure in those considered high-risk for surgery. Our aim was to describe our large single-center experience.

Methods: The cohort included all consecutive patients who have undergone transcatheter PVL closure between February 2005 and august 2017 in our hospital, for the two main indications of heart failure (HF) and hemolytic anemia (HA). We have collected data regarding rates of procedural success and complications, improvement in indication-specific outcomes and mortality. The mean follow-up was 5.6+-6.1 years.

Results: 88 procedures were performed in 77 patients. Mean age was 62.56 ± 15.197, and 45.4 % were female patients. The device was successfully implanted in 70 procedures (79.5%). 45 patients were treated for HF, 32 for HA. Patients who presented with HF had a significant improvement in the NYHA Score (2.13 ± 0.757 after the procedure vs 3.17 ± 0.491 at baseline, P<0.001) (Fig. 1). For patients who presented with HA, there was a significant reduction in LDH level (1354.90 ± 1225.55 vs. 2039.40 ± 1347.20, P<0.001) following the procedure (Fig. 2), as well as increase in hemoglobin (11.54 ± 1.634 vs. 9.72 ± 1.49, P<0.001). Periprocedural complication rate was 7.9%. Rates of mortality were 3.8% at 90days, 15.6% after one year, and 27.2% after 5 years.

Conclusions: For patients who are deemed high-risk for repeat surgery, transcatheter PVL closure shows reasonable clinical success rates, with a significant improvement in symptoms, as divided by indication, and a relatively low rate of periprocedural complications.