Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

• Published in: Arquivos brasileiros de cardiologia 2016-07, Vol.107 (1), p.55-62
• Main Authors: Pinheiro, Carlos Passos, Rezek, Daniele, Costa, Eduardo Paiva, Carvalho, Edvagner Sergio Leite de, Moscoso, Freddy Antonio Brito, Taborga, Percy Richard Chavez, Jeronimo, Andreia Dias, Abizaid, Alexandre Antonio Cunha, Ramos, Auristela Isabel de Oliveira
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic Valve - surgery; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Bioprosthesis - adverse effects; CARDIAC & CARDIOVASCULAR SYSTEMS; Doenças das Valvas Cardíacas / cirurgia; Echocardiography, Transesophageal; Ecocardiografia Transesofagiana; Female; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Hospitalization; Humans; Insuficiência da Valva Aórtica / cirurgia; Insuficiência da Valva Mitral / cirurgia; Male; Middle Aged; Mitral Valve - surgery; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Original; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - mortality; Postoperative Complications - mortality; Postoperative Complications - surgery; Próteses Valvulares Cardíacas; Reoperation; Retrospective Studies; Risk Factors; Therapeutic Occlusion - methods; Therapeutic Occlusion - mortality; Time Factors; Treatment Outcome
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20160086

Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.