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. 2022 Aug 18;11(16):4835.
doi: 10.3390/jcm11164835.

Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience

Ignacio Cruz-González  1   2   3 , Pablo Luengo-Mondéjar  1   4 , Blanca Trejo-Velasco  1   5 , Jean C Núñez-García  1   4 , Rocío González-Ferreiro  1   6 , José C Moreno-Samos  1   7 , Mónica Fuertes-Barahona  1   8 , Juan C Rama-Merchán  1   9 , Pablo Antúnez-Muiños  1   2 , Sergio López-Tejero  1   2 , Gilles Barreira de Sousa  1   2 , Javier Rodríguez-Collado  1   2   3 , Javier Martín-Moreiras  1   2   3 , Alejandro Diego-Nieto  1   2   3 , Jesús Herrero-Garibi  1   2   3 , Manuel Barreiro-Pérez  1   6 , Elena Díaz-Peláez  1   2   3 , Pedro L Sánchez Fernández  1   2   3
Affiliations

Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience

Ignacio Cruz-González et al. J Clin Med. .

Abstract

Background: Paravalvular leak occurs in 5-17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis.

Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified.

Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up.

Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.

Keywords: heart failure; hemolytic anemia; mitral regurgitation; paravalvular leaks; percutaneous closure; valvular prosthesis.

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Conflict of interest statement

The authors declare that I. Cruz González is proctor and consultor of Abbott.

Figures

Figure 1
Figure 1
(A,B): mitral PVL by TEE with true-lumen technology and 3D-color TEE. (C): severe mitral regurgitation (septal PVL). (D): AV loop in a bioprosthesis. (E): AVP-III device. (F): nonsignificant mitral regurgitation after PVL closure (Doppler color TEE).
Figure 2
Figure 2
Overall survival after a first percutaneous mitral PVL closure procedure.
Figure 3
Figure 3
Survival free from major adverse cardiovascular events (MACE) for the overall sample.
Figure 4
Figure 4
Survival free from major adverse cardiovascular events (MACE) according to indication for PVL closure.
See this image and copyright information in PMC

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