Author + information
- Robert Kumar,
- Chad Kliger,
- Pablo Diez–Villanueva,
- Jorge Rodriguez–Capitan,
- Teresa Cano,
- Vladimir Jelnin,
- Itzhak Kronzon,
- Leandro Maranan,
- Gila Perk and
- Carlos Ruiz
Prosthetic paravalvular leak (PVL) is a known complication of mitral valve replacement, presenting as congestive heart failure (CHF) and/or hemolysis. Percutaneous closure of PVLs is a less invasive option compared to reoperation, with reasonable technical success and clinical outcomes. Variation in the extent of prosthetic valve dehiscence results in variable PVL size, and the relative outcomes of percutaneous closure of large vs. small leaks is unknown.
We reviewed all consecutive patients from 11/2007 through 11/2012 who underwent percutaneous closure of single mitral PVLs at our institution and who had cardiac CT angiography (CTA) performed prior to the procedure. Patients with multiple PVLs were excluded. PVL size was measured in degrees of prosthetic valve perimeter. Patients were divided into those with large–circumference (≥40 degrees) and small circumference (<40 degrees) PVLs. Procedural characteristics and clinical outcomes were compared.
35 patients underwent closure of 38 PVLs. 3 procedures did not have adequate CTA measurements and were excluded from analysis. Of the 35 procedures included, 21 were small PVLs (mean 25 +/–9 degrees) and 14 were large PVLs (mean 53 +/–13 degrees). Procedural success rates were similar between the groups (90.5% small PVL, 92.8% large PVL, p=0.80). Fluoroscopy times were not significantly different (37 ±23 min vs. 29 ±21 min, p=o.31). Mean number of devices used to close the PVL was greater in the large PVL group (1.0 device vs. 1.5 devices, p=0.05). Clinical success, defined as resolution of symptomatic hemolysis and CHF, was similar between groups (72% vs.86%, p=0.36)
Percutaneous closure of large–circumference PVLs has similar procedural and clinical success rates when compared to closure of small–circumference PVLs, with a higher number of devices needed for closure. Large–sized PVLs can be considered for percutaneous closure in the high–risk patient.
West, Room 2022
Sunday, March 10, 2013, 9:00 a.m.–9:10 a.m.
Session Title: Structural Heart Disease (Non–TAVR)
Abstract Category: 50. TCT@ACC–i2: Mitral ValveDisease
Presentation Number: 2906–9
- 2013 American College of Cardiology Foundation