Transcatheter closure of periprosthetic leaks

Abstract

Percutaneous paravalvular leak closure represents a small but important niche in structural interventions in the current era of interventional cardiology. It is estimated that paravalvular regurgitation affects 2-17% of all implanted prosthetic heart valves (which equates to 500 to 10,200 cases annually). Patients may present with clinical signs and evidence of heart failure, hemolysis or both. Due to the increased morbidity and mortality, reoperation is often best avoided, especially if the underlying perivalvular tissue is friable or heavily calcified. Perimitral defects are usually approached in an antegrade approach via a transeptal puncture; periaortic defects usually in a retrograde approach. Depending on the number, size and shape of the defect(s) - as determined by 2D and 3D echocardiography as well as 4D computed tomography - one or multiple closure devices are deployed using various wiring and anchor techniques. This brief review provides an updated summary of the currently applied paravalvular leak closure techniques.

Keywords: Amplatzer vascular plug; Aortic valve prosthesis; Heart failure; Hemolysis; Mitral valve prosthesis; Paravalvular leak; Transseptal.