Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis

Introduction Paravalvular leak (PVL) after percutaneous transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. Percutaneous PVL closure has been reported for balloon‐expandable valves but not self‐expandable valves. Methods We conducted a review of case...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2014-07, Vol.84 (1), p.147-154
Main Authors: Gafoor, Sameer, Franke, Jennifer, Piayda, Kerstin, Lam, Simon, Bertog, Stefan, Vaskelyte, Laura, Hofmann, Ilona, Sievert, Horst
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic valve
Aortic Valve Stenosis - surgery
Cardiac Catheterization - methods
CoreValve
Female
Follow-Up Studies
Heart Valve Prosthesis
Humans
Male
Morbidity
paravalvular leak closure
Postoperative Complications - surgery
Prosthesis Design
Reoperation
replacement
Retrospective Studies
self-expanding
transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement - adverse effects
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Summary:Introduction Paravalvular leak (PVL) after percutaneous transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. Percutaneous PVL closure has been reported for balloon‐expandable valves but not self‐expandable valves. Methods We conducted a review of cases at our center where patients who received TAVR with self‐expandable valves and went on to develop severe PVL underwent percutaneous closure. Baseline demographic, TAVR procedural, PVL procedural, and follow‐up data were collected. Results A total of five patients with severe PVL after TAVR with a self‐expanding valve underwent percutaneous PVL closure. Four of five patients had a trial of balloon postdilatation after valve deployment and had significant persistent PVL. In all five patients, PVL went from moderate‐severe to mild‐moderate PVL. There were no adverse events. Conclusion Percutaneous PVL closure for severe PVL self‐expanding valve for TAVR is a safe and efficacious procedure. Procedural technique involves transesophageal guidance, a high approach through the valve struts, deployment of an appropriate size device, and careful monitoring. This method may be part of the algorithm for severe PVL after TAVR. © 2013 Wiley Periodicals, Inc.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.25176