Author + information
- Received October 29, 2010
- Revision received February 10, 2011
- Accepted March 10, 2011
- Published online November 15, 2011.
- Carlos E. Ruiz, MD, PhD⁎ (, )
- 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 and
- Howard A. Cohen, MD
- ↵⁎Reprint requests and correspondence:
Dr. Carlos E. Ruiz, Lenox Hill Heart and Vascular Institute, 130 East 77th Street, 9th Floor, Black Hall Building, New York, New York 10021-10075
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 ± 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.
Dr. Ruiz is a consultant to and has received educational grants from Philips Healthcare and TeraRecon, Inc.; and is a proctor for AGA Medical Corp. Dr. Kronzon has received speaking honoraria from Philips Healthcare; and has received a research grant from GE. Dr. Roubin is a consultant to and receives royalties from Cook, Inc., and Abbott Vascular. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received October 29, 2010.
- Revision received February 10, 2011.
- Accepted March 10, 2011.
- American College of Cardiology Foundation