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Percutaneous PVL Closure
Published Case Series
Clinical Outcomes in Patients Undergoing Percutaneous Closure of Periprosthetic Paravalvular Leaks
Carlos E. Ruiz, MD, PHD, Vladimir Jelnin, MD, Itzhak Kronzon, MD, Yuriy Dudiy, MD, Raquel Del Valle-Fernandez, MD, Bryce N. Einhorn, Paul T. L. Chiam, MD, Claudia Martinez, MD, Rocio Eiros, MS, Gary Roubin, MD, PHD, Howard A. Cohen, MD New York, New York Center for Valve and Structural Heart Disease
Fluoroscopy time 39 min. Eventual technical success 86% Procedural failures N=12 (21%) Inability to cross defect N=8 (14%) Interference with valve N=3 (5%) Wire entrapment N=1 (2%) Complications N=7 (12%) Acute embolization N=2 (4%) Wire entrapment N=1 (2%) Cardiac perforation N=2 (4%) Iliac artery perforation N=1 (2%) Death N=1 (2%)
Ruiz et al. JACC 2011;58(21):2210
Percutaneous PVL Closure
Published Case Series
Center for Valve and Structural Heart Disease
Of successfully closed 37 patients, 13 (35%) had worsening or new hemolysis post-procedurally.
Ruiz et al. JACC 2011;58(21):2210
Clinical Outcomes in Patients Undergoing Percutaneous Closure of Periprosthetic Paravalvular Leaks
Carlos E. Ruiz, MD, PHD, Vladimir Jelnin, MD, Itzhak Kronzon, MD, Yuriy Dudiy, MD, Raquel Del Valle-Fernandez, MD, Bryce N. Einhorn, Paul T. L. Chiam, MD, Claudia Martinez, MD, Rocio Eiros, MS, Gary Roubin, MD, PHD, Howard A. Cohen, MD New York, New York Center for Valve and Structural Heart Disease
Percutaneous PVL Closure
Most Contemporary Series
patients
- 20 centers over 11 years
- 44% mitral, 48% aortic PVL
- Technical success 91%
- NYHA class improved from
2.7 to 1.6
- Hospital mortality was 2.9%
in elective cases
- Factors associated with poor
- utcome were persistent leak
and renal function
Calvert PA et al., Circulation 2016: 10.1161/CIRCULATIONAHA.116.022684
Percutaneous Device Closure of Paravalvular Leak: Combined Experience from the United Kingdom and Ireland
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- Center for Valve and Structural Heart Disease
Percutaneous PVL Closure
Most Contemporary Series
- Between 2008-2014: 51 percutaneous closures, 36 surgical
closure
- Propensity score match in-hospital mortality: 9.8%
percutanous vs. 30.% surgical; OR 6, p=0.01
- Clinical improvement was higher in percutaneous group
(71.4% vs. 36.4%; p=0.002)
Angulo-Llanos R et ak. CCI 2016: DOI: 10.1002/ccd.26459
Two-Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non-Randomized Analysis
TABLE VII. Short-Term Outcomes: Mitral and Aortic Patients Percutaneous mitral (41) Surgical mitral (26) P Percutaneous aortic (10) Surgical aortic (10) P Length of stay after procedure 11.6 20.1 d 34.5 29.1 d <0.001 4 3.7 d 26.44 17.1 d 0.008 In-Hospital mortality 12.2% (5) 30.8% (8) 0.06 30% (3) 0.105 Complications Cerebrovascular accident 20% (2) 0.24 Renal insufficiency 9.7% ( 4) 57.7% (15) <0.001 50% (5) 0.016 Vascular complications 19.6 % ( 10) 11.5% (3) 0.37 20% (2) 10% (1) 0.5 Values are presented as mean 6 SD, count or % (n).
