Clinical Outcomes in Patients Undergoing Percutaneous Closure of Periprosthetic Paravalvular Leaks

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• 作者：Carlos E.  ; Ruiz MD ; PhD  ; ;   ; ^{cruiz@nshs.edu} ; Vladimir  ; Jelnin MD ; Itzhak  ; Kronzon MD ; Yuriy  ; Dudiy MD ; Raquel  ; Del Valle-Fernandez MD ; Bryce N.  ; Einhorn ; Paul T.L.  ; Chiam MD ; Claudia  ; Martinez MD ; Rocio  ; Eiros MS ; Gary  ; Roubin MD ; PhD ; Howard A.  ; Cohen MD
• 关键词：device closure ; paravalvular leak ; prosthetic valve
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：15 November 2011
• 年：2011
• 卷：58
• 期：21
• 页码：2210-2217
• 全文大小：1419 K

文摘

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Objectives

The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia.

Background

Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair of this defect in high-risk surgical patients.

Methods

This is a retrospective review of 57 percutaneous paravalvular leak closures that were performed in 43 patients (67 % male, mean age 69.4 ¡À 11.7 years) between April 2006 and September 2010. Integrated imaging modalities were used for the evaluation, planning, and guidance of the interventions.

Results

Closure was successful in 86 % of leaks and in 86 % of patients. Twenty-eight of 35 patients improved by at least 1 New York Heart Association functional class. The percentage of patients requiring blood transfusions and/or erythropoietin injections post-procedure decreased from 56 % to 5 % . Clinical success was achieved in 89 % of the patients in whom procedure was successful. The survival rates for patients at 6, 12, and 18 months after paravalvular leak closures were 91.9 % , 89.2 % , and 86.5 % , respectively. Freedom from cardiac-related death at 42 months post-procedure was 91.9 % .

Conclusions

Percutaneous closure of symptomatic paravalvular leaks, facilitated by integrated imaging modalities has a high rate of acute and long-term success and appears to be effective in managing symptoms of heart failure and hemolytic anemia.