Transapical treatment of paravalvular leaks in patients with a logistic EuroSCORE of more than 15%: acute and 3-month outcomes of a "proof of concept" study

• Published in: Catheterization and cardiovascular interventions 2012-04, Vol.79 (5), p.741-747
• Main Authors: Swaans, Martin J, Post, Martijn C, van der Ven, H A Johan, Heijmen, Robin H, Budts, Werner, ten Berg, Jurien M
• Format: Article
• Language: English
• Subjects: Aged; Aortic Valve - surgery; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Equipment Failure Analysis; Female; Fluoroscopy; Follow-Up Studies; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Logistic Models; Male; Minimally Invasive Surgical Procedures - methods; Mitral Valve - surgery; Netherlands; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - therapy; Prosthesis Failure; Reoperation - methods; Risk Assessment; Sampling Studies; Survival Analysis; Thoracotomy - methods; Treatment Outcome; Unnecessary Procedures
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.23264

We describe the short-term results of the patients who underwent transapical treatment of a paravalvular leak (PVL) in our centre. Increasing experience with transapical aortic valve implantation has inspired us to explore this approach for prosthetic paravalvular leak reduction in high risk patients. All procedures were performed in the catheterization laboratory under general anesthesia, using a small anterolateral thoracotomy to expose the apex. Access through a 9-French sheath was necessary to introduce the Amplatzer Vascular III plug. Three-dimensional transesophageal echocardiography (3D-TEE) was used to guide the operator and evaluate the severity of regurgitation postimplantation. In total seven consecutive patients (mean age 72.8 ± 5.6 years, 86% male) with a history of mitral valve (n = 6) or aortic valve replacement and severe PVL, underwent transapical PVL reduction using seven plugs in total (diameter 10-14 mm). Preprocedural median logistic EuroSCORE was 28.5% (range 17.1-41.1%) and NYHA functional class was ≥3 in all patients. The procedure was successful in all patients, with a median fluoroscopic time of 18.7 min (range 10.1-29.6 min). Postprocedure 3D-TEE showed occlusion of PVL in three patients, and significant reduction in three patients. Postprocedural complication was a hematothorax requiring surgery in one patient. Median hospitalization duration after the procedure was 5 days (range 5-59 days). At 3-month follow-up one patient died, functional class and LDH did not differ significantly and there was a significant increase in hemoglobin. Transapical paravalvular leak reduction might be a good or rather attractive alternative in high-risk patients for major re-do cardiac surgery.