Download PDF
Thorac Cardiovasc Surg 2020; 68(02): 148-157
DOI: 10.1055/s-0038-1639334
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Prognosis of Transcatheter Closure Compared with Surgical Repair of Paravalvular Leak after Prosthetic Valve Replacement: A Retrospective Comparison

Chun Yang
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Yang Liu
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Jiayou Tang
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Ping Jin
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Lanlan Li
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Shiqiang Yu
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
,
Jian Yang
1   Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi, Republic of China
› Author Affiliations Sources of Funding This study was supported by funding from the National Natural Science Foundation of China (grants 81470500 and 81500319) and the Distinguished Young Scholar Cultivation Project of Xijing Hospital (XJZT14J03, XJZT15ZL01).
Further Information

Publication History

23 October 2017

05 February 2018

Publication Date:
08 May 2018 (online)

    Permissions and Reprints All articles of this category

Abstract

Objective Paravalvular leak (PVL) after valve replacement remains clinically challenging. Percutaneous closure is an effective therapy for patients with PVLs because reoperation is associated with high rates of morbidity and mortality. The purpose of this study was to retrospectively compare the clinical outcome of transcatheter closure and surgical repair in patients with a PVL.

Methods From January 2000 to May 2016, 131 patients with PVL were treated at three major medical centers in China. Perioperative characteristics and outcomes of the procedure were reviewed.

Results Sixty-eight (51.9%) patients with PVLs were treated with percutaneous transcatheter closure (group I). The procedure was successful in 67 (98%) with no hospital deaths. Sixty-three (48.1%) patients with PVLs had a reoperation (group II). Five of the surgical patients had a third open-heart operation for residual regurgitation, and one underwent successful percutaneous closure. Six patients died in the hospital postoperatively. All patients in group II but only 11 in group I needed perioperative blood transfusions. The procedural time and hospital stay after the procedure were significantly shorter in group I than in group II. At the 1-year follow-up, cardiac function improved by ≥ 1 New York Heart Association functional class in 55 (82%) patients in group I and in 39 (68%) patients in group II.

Conclusions Transcatheter closure was shown to be a safe, effective therapeutic option in patients with PVL. It was associated with a lower hospital mortality rate, shorter procedural time, and fewer blood transfusions than surgical treatment in selected patients.

Keywords

paravalvular leak - valve replacement - transapical - transcatheter - surgery - follow-up
 

  • References

  • 1 Sorajja P, Bae R, Lesser JA, Pedersen WA. Percutaneous repair of paravalvular prosthetic regurgitation: patient selection, techniques and outcomes. Heart 2015; 101 (09) 665-673
    CrossrefPubMedSearch in Google Scholar
  • 2 Hwang HY, Choi JW, Kim HK, Kim KH, Kim KB, Ahn H. Paravalvular leak after mitral valve replacement: 20-year follow-up. Ann Thorac Surg 2015; 100 (04) 1347-1352
    CrossrefPubMedSearch in Google Scholar
  • 3 Hourihan M, Perry SB, Mandell VS. , et al. Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol 1992; 20 (06) 1371-1377
    CrossrefPubMedSearch in Google Scholar
  • 4 Ruiz CE, Jelnin V, Kronzon I. , et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol 2011; 58 (21) 2210-2217
    CrossrefPubMedSearch in Google Scholar
  • 5 Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. The learning curve in percutaneous repair of paravalvular prosthetic regurgitation: an analysis of 200 cases. JACC Cardiovasc Interv 2014; 7 (05) 521-529
    CrossrefPubMedSearch in Google Scholar
  • 6 Xu CN, Liu Y, Li XF. , et al. [Efficacy of interventional therapy on paravalvular leakage after mitral valve replacement]. Zhonghua Xin Xue Guan Bing Za Zhi 2016; 44 (03) 238-243
    PubMedSearch in Google Scholar
  • 7 Li XF, Liu Y, Chen WS. , et al. Evaluation of the safety and efficacy of transcatheter intervention of paravalvular leakage (pvl) after aortic valve replacement: 15 case reports. Zhonghua Xiong Xin Xue Guan Wai Ke Za Zhi 2015; 31: 748-751
    PubMedSearch in Google Scholar
  • 8 Taramasso M, Maisano F, Latib A. , et al. Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience. Eur Heart J Cardiovasc Imaging 2014; 15 (10) 1161-1167
    CrossrefPubMedSearch in Google Scholar
  • 9 Angulo-Llanos R, Sarnago-Cebada F, Rivera AR. , et al. Two-year follow up after surgical versus percutaneous paravalvular leak closure: a non-randomized analysis. Catheter Cardiovasc Interv 2016; 88 (04) 626-634
    CrossrefPubMedSearch in Google Scholar
  • 10 Williams MR, Koeckert MS, Grossi EA. Rethinking the gold standard for correction of paravalvular leak. J Thorac Cardiovasc Surg 2016; 151 (05) 1267-1268
    CrossrefPubMedSearch in Google Scholar
  • 11 Taramasso M, Maisano F, Pozzoli A, Alfieri O, Meier B, Nietlispach F. Catheter-based treatment of paravalvular leaks. EuroIntervention 2016; 12 (Suppl X): X55-X60
    CrossrefPubMedSearch in Google Scholar
  • 12 Smolka G, Pysz P, Kozłowski M. , et al. Transcatheter closure of paravalvular leaks using a paravalvular leak device - a prospective Polish registry. Postepy Kardiol Interwencyjnej 2016; 12 (02) 128-134 [Advances in Interventional Cardiology]
    PubMedSearch in Google Scholar
  • 13 Pinheiro CP, Rezek D, Costa EP. , et al. Paravalvular regurgitation: clinical outcomes in surgical and percutaneous treatments. [Article in English, Portuguese] Arq Bras Cardiol 2016; 107 (01) 55-62
    PubMedSearch in Google Scholar
  • 14 Nietlispach F, Maisano F, Sorajja P, Leon MB, Rihal C, Feldman T. Percutaneous paravalvular leak closure: chasing the chameleon. Eur Heart J 2016; 37 (47) 3495-3502
    CrossrefPubMedSearch in Google Scholar
  • 15 Cruz-Gonzalez I, Rama-Merchan JC, Calvert PA. , et al. Percutaneous closure of paravalvular leaks: a systematic review. J Interv Cardiol 2016; 29 (04) 382-392
    CrossrefPubMedSearch in Google Scholar
  • 16 Spoon DB, Malouf JF, Spoon JN. , et al. Mitral paravalvular leak: description and assessment of a novel anatomical method of localization. JACC Cardiovasc Imaging 2013; 6 (11) 1212-1214
    PubMedSearch in Google Scholar
  • 17 Rihal CS, Sorajja P, Booker JD, Hagler DJ, Cabalka AK. Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv 2012; 5 (02) 121-130
    CrossrefPubMedSearch in Google Scholar
  • 18 Bouhout I, Mazine A, Ghoneim A. , et al. Long-term results after surgical treatment of paravalvular leak in the aortic and mitral position. J Thorac Cardiovasc Surg 2016; 151 (05) 1260-6.e1
    CrossrefPubMedSearch in Google Scholar
  • 19 Taramasso M, Maisano F, Denti P. , et al. Surgical treatment of paravalvular leak: long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg 2015; 149 (05) 1270-1275
    CrossrefPubMedSearch in Google Scholar
  • 20 Kim SJ, Samad Z, Bloomfield GS, Douglas PS. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement. Am Heart J 2014; 168 (02) 150-9.e1 , 7
    CrossrefPubMedSearch in Google Scholar
  • 21 Choi JW, Hwang HY, Kim KH, Kim KB, Ahn H. Long-term results of surgical correction for mitral paravalvular leak: repair versus re-replacement. J Heart Valve Dis 2013; 22 (05) 682-687
    PubMedSearch in Google Scholar
  • 22 Akins CW, Bitondo JM, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks. J Heart Valve Dis 2005; 14 (06) 792-799 , discussion 799–800
    PubMedSearch in Google Scholar
  • 23 Kliger C, Ruiz CE. Rethinking percutaneous paravalvular leak closure: where do we go from here?. Rev Esp Cardiol (Engl Ed) 2014; 67 (08) 593-596
    CrossrefPubMedSearch in Google Scholar
  • 24 Kumar R, Jelnin V, Kliger C, Ruiz CE. Percutaneous paravalvular leak closure. Cardiol Clin 2013; 31 (03) 431-440
    CrossrefPubMedSearch in Google Scholar