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. 2017 Apr 1;13(3):575-584.
doi: 10.5114/aoms.2016.60435. Epub 2016 Jun 13.

Transcatheter paravalvular leak closure and hemolysis - a prospective registry

Grzegorz Smolka  1 , Piotr Pysz  1 , Andrzej Ochała  1 , Michał Kozłowski  1 , Wojciech Zasada  2   3 , Zofia Parma  1 , Michał Tendera  1 , Wojciech Wojakowski  1
Affiliations

Transcatheter paravalvular leak closure and hemolysis - a prospective registry

Grzegorz Smolka et al. Arch Med Sci. .

Abstract

Introduction: Paravalvular leak (PVL) related to a surgical prosthetic valve may be associated with clinically significant hemolysis. The influence of transcatheter PVL closure (TPVLC) on hemolysis remains uncertain.

Material and methods: The prospective registry included patients undergoing TPVLC due to PVL-related heart failure and/or hemolysis. Procedural data, laboratory markers of hemolysis and heart failure status were recorded at baseline, discharge and at 1- and 6-month follow-up.

Results: Of 116 patients from all those qualified for TPVLC, 79 fulfilled the inclusion/exclusion criteria. Hemolysis was significantly more frequent in patients with mitral location of PVL and with calcifications in its channel. After TPVLC prompt reduction of lactate dehydrogenase activity (617.0 (342.0-899.0) vs. 397 (310.0-480.5) IU/l, p < 0.05) and gradual resolution of anemia (hemoglobin (HGB) 11.7 (10.4-13.8) vs. 13.4 (12.9-13.8) g%, p < 0.05) over 6 months were noted. Effective closure of PVL (> 90% reduction of PVL cross-sectional area) resulted in a more prominent increase of red blood cell count and HGB than in patients with residual regurgitation. The TPVLC-related exacerbation of hemolysis was recorded in 14 patients. Its risk was aggravated by presence of significant hemolysis at baseline or residual flow either by a partially uncovered channel or across the occluder. Reduction of hemolysis after successful TPVLC was sustained in 6-month follow-up.

Conclusions: Risk factors for PVL-related hemolysis were the presence of calcifications in the defect and mitral location of PVL. The TPVLC effectively reduced hemolysis if at least 90% reduction of PVL cross sectional area was achieved. The effect was sustained in 6-month follow-up. Incomplete closure of PVL may increase the magnitude of hemolysis after TPVLC, but it occurred rarely.

Keywords: hemolysis; occluder; paravalvular leak; percutaneous closure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A – Multi-planar reconstruction of RT 3D TEE data set – measurement of CSA (left panel) and minimum and maximum dimensions (right panel) of mitral PVL. B – Assessment of the completeness of PVL sealing – comparison of baseline (left panel) vs. postprocedural (right panel) CSA of PVL – 75% reduction of aortic PVL CSA. C – Visualization of residual regurgitant flow through the structure of the PLD occluder (dotted black line). D – An example of a calcified PVL channel (dotted black line)
Figure 2
Figure 2
Lactate dehydrogenase activity during 6-month follow-up in all patients
Figure 3
Figure 3
Lactate dehydrogenase activity in patients with TPVLC-related hemolysis
Figure 4
Figure 4
Changes of LDH activity in pairs of samples
See this image and copyright information in PMC

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