Abstract
Aims
Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL.
Methods
Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement.
Results
Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups.
Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003).
There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table).
Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577
Conclusions
In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.
Percutaneous closure of an aortic prosthetic paravalvular leak with device in a patient presenting with heart failure
