PMID- 33648808
OWN - NLM
STAT- MEDLINE
DCOM- 20210831
LR  - 20210831
IS  - 2174-2049 (Electronic)
IS  - 2174-2049 (Linking)
VI  - 40
IP  - 4
DP  - 2021 Apr
TI  - Paravalvular leak closure: Still a challenge with unpredictable results.
PG  - 261-269
LID - S0870-2551(21)00040-8 [pii]
LID - 10.1016/j.repc.2020.07.016 [doi]
AB  - INTRODUCTION: Paravalvular leak (PVL) is a common serious complication associated 
      with prosthetic valve implantation. OBJECTIVE: The aim of this study was to 
      report our single-center experience in a retrospective review and to analyze 
      possible predictors of success. METHODS: We performed 33 percutaneous PVL 
      closures in 26 patients (54% female, mean age 65+/-13 years). All mitral prostheses 
      were studied previously with 3D transesophageal echocardiography (TEE), and 
      aortic prostheses with 2D/3D TEE. 3D TEE and fluoroscopy were used for the 
      assessment, planning, and guidance of the interventions. Twelve patients also 
      underwent computed tomography angiography for better characterization of anatomic 
      details. RESULTS: Eighteen patients (69.2%) were admitted due to heart failure 
      (New York Heart Association [NYHA] III or IV, seven (26.9%) because of heart 
      failure and hemolysis, and one (3.8%) due to hemolysis only. Regarding the leaks, 
      46.2% were in aortic and 53.8% in mitral prostheses, 88.5% in mechanical and 7.7% 
      in biological prostheses, and 3.8% in transcatheter aortic valve implants. All 
      the aortic patients had severe aortic regurgitation. Furthermore, all mitral 
      patients but one had moderate to severe or severe mitral regurgitation. Closure 
      was successful in 17 patients (65.4%), partially successful in four (15.4%) and 
      unsuccessful in five (19.2%). After the procedure, 69% were in NYHA I-II. 
      Hemolysis worsened in three patients despite successful closure; all required 
      further valvular surgery and two died. Regarding angiographic and 
      echocardiographic procedural success, we analyzed age, gender, type of prosthesis 
      (mechanical or biological), location (aortic or mitral), clinical data, maximum 
      leak diameter, anatomic regurgitant orifice, leak location (anterior, posterior, 
      inferior and lateral for mitral leaks and left, right and non-coronary sinus for 
      aortic leaks), and number of devices (plugs) used for closure. No parameters 
      presented a significant relationship with success excepting previous hemolysis. 
      There was a relationship between clinical improvement and reduction of PVL 
      (p=0.0001). In follow-up, cardiac-related events (new hospital admissions, 
      cardiac valvular surgery, need for transfusion) were more frequent in patients 
      with partially successful or unsuccessful closure (p=0.012). There was a 
      relationship between cardiac-related events and death (p=0.029). CONCLUSION: 
      Percutaneous PVL closure has emerged as an alternative treatment for PVL. 
      Predictors of procedural success are difficult to establish. Survival is related 
      to reduction of regurgitation and improvement in NYHA functional class.
CI  - Copyright (c) 2021 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier 
      Espana, S.L.U. All rights reserved.
FAU - Galrinho, Ana
AU  - Galrinho A
AD  - Hospital de Santa Marta, Lisboa, Portugal. Electronic address: 
      anaisabelgalrinho@gmail.com.
FAU - Branco, Luisa M
AU  - Branco LM
AD  - Hospital de Santa Marta, Lisboa, Portugal.
FAU - Fiarresga, Antonio
AU  - Fiarresga A
AD  - Hospital de Santa Marta, Lisboa, Portugal.
FAU - Cacela, Duarte
AU  - Cacela D
AD  - Hospital de Santa Marta, Lisboa, Portugal.
FAU - Sousa, Lidia
AU  - Sousa L
AD  - Hospital de Santa Marta, Lisboa, Portugal.
FAU - Ramos, Ruben
AU  - Ramos R
AD  - Hospital de Santa Marta, Lisboa, Portugal.
FAU - Ferreira, Rui C
AU  - Ferreira RC
AD  - Hospital de Santa Marta, Lisboa, Portugal.
LA  - eng
LA  - por
PT  - Journal Article
DEP - 20210227
PL  - Spain
TA  - Rev Port Cardiol (Engl Ed)
JT  - Revista portuguesa de cardiologia
JID - 101770878
SB  - IM
CIN - Rev Port Cardiol (Engl Ed). 2021 Apr;40(4):271-272. PMID: 33722448
MH  - Aged
MH  - *Echocardiography, Three-Dimensional
MH  - Echocardiography, Transesophageal
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Devices
OT  - Dispositivos
OT  - Leaks perivalvulares
OT  - Paravalvular leaks
OT  - Periprosthetic regurgitation
OT  - Regurgitacao peri-protesica
EDAT- 2021/03/03 06:00
MHDA- 2021/09/01 06:00
CRDT- 2021/03/02 05:49
PHST- 2020/04/03 00:00 [received]
PHST- 2020/06/29 00:00 [revised]
PHST- 2020/07/15 00:00 [accepted]
PHST- 2021/03/03 06:00 [pubmed]
PHST- 2021/09/01 06:00 [medline]
PHST- 2021/03/02 05:49 [entrez]
AID - S0870-2551(21)00040-8 [pii]
AID - 10.1016/j.repc.2020.07.016 [doi]
PST - ppublish
SO  - Rev Port Cardiol (Engl Ed). 2021 Apr;40(4):261-269. doi: 
      10.1016/j.repc.2020.07.016. Epub 2021 Feb 27.