Author + information
- Sidakpal Panaich1,
- Elad Maor1,
- Gautam Reddy1,
- Claire Raphael1,
- Allison Cabalka1,
- Donald Hagler2,
- Guy Reeder3,
- Chet Rihal1 and
- Mackram Eleid1
Paravalvular leaks (PVL) are relatively common after surgical valve replacement and can result in heart failure symptoms or hemolysis. Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients, little is known about its effect on hemolysis.
We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (Jan 2005-Dec 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH activity and/or haptoglobin levels) were included. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dl, decrease in LDH above the median or an improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis.
Final study population included 168 patients (130 mitral and 38 aortic). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.7 ± 1.7 mg/dl in patients who reached the primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) post-procedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were twice as likely to have a successful outcome (p = 0.044). Degree of residual PVL after closure was not associated with successful reduction of hemolysis.
Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most profound in patients with mechanical valves.
STRUCTURAL: Valvular Disease: Other