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Long-Term Outcomes of Catheter-Based Intervention for Clinically Significant Paravalvular Leak.

BACKGROUND
In most centers, clinically significant percutaneous paravalvular leak (PVL) closure following valve replacement surgery is reserved for those considered high-risk for surgery. There is paucity of data regarding long-term outcomes of these patients.


AIMS
Our goals were to assess long-term outcomes of patients undergoing percutaneous PVL closure.


METHODS
100 consecutive transcatheter PVL closure procedures (74 mitral, 26 aortic) were performed in 95 patients between February 2005 and august 2019 at our hospital. Data collected included: procedural success rates, indication-specific outcomes and mortality.


RESULTS
Mean follow-up was 5.6±6.1 years, mean age 62.6±15.2, 45.4 % were female. The device was successfully implanted in 88 procedures (88.0%). Patients who presented with heart failure (n-57) had a significant improvement in the NYHA classification (29.2% class 3/4 versus 100.0%, P<0.001). For patients who presented with hemolytic anemia (n-38), hemoglobin increased (11.94±1.634 vs. 9.72±1.49, P<0.001) and LDH levels were reduced (1,354.90±1,225.55 vs. 2,039.40±1,347.20, P<0.001) following the procedure. Rates of mortality were 3.8% at 90 days, 15.6% after one year, and 27.2% after 5 years.


CONCLUSIONS
For patients who are deemed intermediate to high-risk for repeat surgery, transcatheter PVL closure shows reasonable clinical success rates, with a significant improvement in symptoms, and a relatively low rate of periprocedural complications.