INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

AORTIC PARAVALVULAR LEAK CLOSURE

Mehmet Erdoğan

Yıldırım Beyazıt University, Faculty of Medicine, Bilkent City Hospital, Department of Cardiology, Ankara, Türkiye

Erdoğan M. Aortic Paravalvular Leak Closure. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.269-282.

ABSTRACT

The incidence of aortic paravalvular leak (PVL) after surgical prosthetic valve implantation ranges from 2-10%, and this rate increases up to 25% following transcatheter aortic valve implantation (TAVI). The most significant risk factors for PVL include annular calcification, endocarditis, and tissue friability. Patients often present with heart failure and hemolysis. Surgical or transcatheter treatments are recommended for patients with symptomatic and significant paravalvular regurgitation. Traditionally, the first-line treatment option is surgery; however, the mortality rate for re-do surgery ranges from 6-22%. Therefore, transcatheter treatment presents a good alternative, especially for patients at high or prohibitive surgical risk and those with suitable anatomical conditions. Comprehensive echocardiographic evaluation is crucial before deciding on treatment. Before PVL closure, it is important to confirm the absence of mechanical instability, significant stenosis, and active infection in the prosthetic valve. Multimodal imaging methods are often required for determining the size and location of the defect and for device selection. Success rates for transcatheter PVL closure are comparable to surgery, moreover early adverse events are more favorable in transcatheter procedures. This chapter discusses the clinical presentation, diagnosis, imaging techniques, procedural approaches, devices used in transcatheter closure, and clinical study outcomes for aortic PVL.

Keywords: Aortic valve disease; Aortic valve insufficiency; Vascular closure devices; Transcatheter aortic valve replacement

Referanslar

  1. Kumar R, Jelnin V, Kliger C, Ruiz CE. Percutaneous paravalvular leak closure. Cardiol Clin. 2013;31(3):431-40. [Crossref]  [PubMed]
  2. Kliger C, Eiros R, Isasti G, Einhorn B, Jelnin V, Cohen H, et al. Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure. Eur Heart J. 2013;34(9):638-49. [Crossref]  [PubMed]
  3. Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, et al. Paravalvular Leak Academic Research Consortium. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis: An Expert Statement. J Am Coll Cardiol. 2017;69(16):2067-2087. [Crossref]  [PubMed]
  4. Flores-Umanzor E, Nogic J, Cepas-Guillén P, Hascoet S, Pysz P, Baz JA, et al. Percu-taneous paravalvular leak closure after transcatheter aortic valve implantation: the inter-national PLUGinTAVI Registry. EuroIntervention. 2023;19(5):e442-e449. [Crossref]  [PubMed]  [PMC]
  5. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. PARTNER Trial Investigators. Twoyear outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686-95. [Crossref]  [PubMed]
  6. Rihal CS, Sorajja P, Booker JD, Hagler DJ, Cabalka AK. Principles of percutaneous pa-ravalvular leak closure. JACC Cardiovasc Interv. 2012;5(2):121-30. [Crossref]  [PubMed]
  7. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. PART-NER 2 Investigators. Transcatheter or Surgical Aortic-Valve Replacement in Intermedia-te-Risk Patients. N Engl J Med. 2016;374(17):1609-20. [Crossref]  [PubMed]
  8. Taramasso M, Maisano F, Denti P, Guidotti A, Sticchi A, Pozzoli A, et al. Surgical tre-atment of paravalvular leak: Long-term results in a single-center experience (up to 14 ye-ars). J Thorac Cardiovasc Surg. 2015;149(5):1270-5. [Crossref]  [PubMed]
  9. Taramasso M, Maisano F, Latib A, Denti P, Guidotti A, Sticchi A, et al. Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience. Eur Heart J Cardio-vasc Imaging. 2014;15(10):1161-7. [Crossref]  [PubMed]
  10. Smolka G, Pysz P, Jasiński M, Roleder T, Peszek-Przybyła E, Ochała A, et al. Mul-tiplug paravalvular leak closure using Amplatzer Vascular Plugs III: A prospective re-gistry. Catheter Cardiovasc Interv. 2016;87(3):478-87. [Crossref]  [PubMed]
  11. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Long-term follow-up of percutaneous re-pair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011;58(21):2218-24. [Crossref]  [PubMed]
  12. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Percutaneous repair of paravalvular prost-hetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv. 2011;4(4):314-21. [Crossref]  [PubMed]
  13. Ruiz CE, Jelnin V, Kronzon I, Dudiy Y, Del Valle-Fernandez R, Einhorn BN, et al. Cli-nical outcomes in patientsundergoing percutaneous closure of periprosthetic paravalvu-lar leaks. J Am Coll Cardiol. 2011;58(21):2210-7. [Crossref]  [PubMed]
  14. Alkhouli M, Sarraf M, Maor E, Sanon S, Cabalka A, Eleid MF, Hagler DJ, Pollak P, Reeder G, Rihal CS. Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure. JACC Cardiovasc Interv. 2016;9(23):2416-2426. [Crossref]  [PubMed]
  15. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. The learning curve in percutaneous repair of paravalvular prosthetic regurgitation: an analysis of 200 cases. JACC Cardiovasc In-terv. 2014;7(5):521-9. [Crossref]  [PubMed]
  16. Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, et al. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Car-diol. 2022;47(10):100957. [Crossref]  [PubMed]
  17. Wells JA 4th, Condado JF, Kamioka N, Dong A, Ritter A, Lerakis S, et al. Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches. JACC Cardiovasc Interv. 2017;10(5):500-507. [Crossref]  [PubMed]
  18. Laakso T, Laine M, Moriyama N, Dahlbacka S, Airaksinen J, Virtanen M, et al. Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement. Eur J Cardiothorac Surg. 2020 ;58(6):1145-1152. [Crossref]  [PubMed]
  19. Freixa X, Gabani R, Cepas-Guillén P, Flores-Umanzor E, Estévez-Loureiro R, Onorato EM. Paravalvular Leakages after Surgical Aortic-Valve Replacement and after Transcat-heter Aortic-Valve Implantation: Strategies to Increase the Success Rate of Percutaneous Closure. J Clin Med. 2022;11(11):2989. [Crossref]  [PubMed]  [PMC]
  20. Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgi-tation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging. 2015;8(3):340-360. [Crossref]  [PubMed]
  21. Ribeiro HB, Orwat S, Hayek SS, Larose É, Babaliaros V, Dahou A, et al. Cardiovascu-lar Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Val-ve Replacement. J Am Coll Cardiol. 2016;68(6):577-585. [Crossref]  [PubMed]
  22. Suchá D, Symersky P, Tanis W, Mali WP, Leiner T, van Herwerden LA, et al. Multimo-dality Imaging Assessment of Prosthetic Heart Valves. Circ Cardiovasc Imaging. 2015;8(9):e003703. [Crossref]  [PubMed]
  23. Merten C, Beurich HW, Zachow D, Mostafa AE, Geist V, Toelg R, et al. Aortic regurgi-tation and left ventricular remodeling after transcatheter aortic valve implantation: a serial cardiac magnetic resonance imaging study. Circ Cardiovasc Interv. 2013;6(4):476-83. [Crossref]  [PubMed]
  24. Thomas C, Kirschbaum A, Boehm D, Thomas L. The diagnostic plot: a concept for identifying different states of iron deficiency and monitoring the response to epoetin the-rapy. Med Oncol. 2006;23(1):23-36. [Crossref]  [PubMed]
  25. Biner S, Kar S, Siegel RJ, Rafique A, Shiota T. Value of color Doppler three-dimensional transesophageal echocardiography in the percutaneous closure of mitral prosthesis paravalvular leak. Am J Cardiol. 2010;105(7):984-9. [Crossref]  [PubMed]
  26. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. [Crossref]  [PubMed]
  27. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clini-cal Practice Guidelines. Circulation. 2022;145(18):e895-e1032. [Crossref]  [PubMed]
  28. Gafoor S, Steinberg DH, Franke J, Bertog S, Vaskelyte L, Hofmann I, et al. Tools and techniques-clinical: paravalvular leak closure. EuroIntervention. 2014;9(11):1359-63. [Crossref]  [PubMed]
  29. Sato H, Sorajja P. Paravalvular Regurgitation: an Overview of Indications for Closure and Management Strategies. Curr Cardiol Rep. 2022;24(5):577-586. [Crossref]  [PubMed]
  30. Eleid MF, Cabalka AK, Malouf JF, Sanon S, Hagler DJ, Rihal CS. Techniques and Out-comes for the Treatment of Paravalvular Leak. Circ Cardiovasc Interv. 2015;8(8):e001945. [Crossref]  [PubMed]
  31. Feldman T, Salinger MH, Levisay JP, Smart S. Low profile vascular plugs for paraval-vular leaks after TAVR. Catheter Cardiovasc Interv. 2014;83(2):280-8. [Crossref]  [PubMed]
  32. Cruz-Gonzalez I, Rama-Merchan JC, Rodríguez-Collado J, Martín-Moreiras J, Diego-Nieto A, Barreiro-Pérez M, Sánchez PL. Transcatheter closure of paravalvular leaks: sta-te of the art. Neth Heart J. 2017;25(2):116-124. [Crossref]  [PubMed]  [PMC]