Characteristics and outcomes of re-do percutaneous paravalvular leak closure: Re-Do percutaneous paravalvular leak closure

Mohammed A. Al-Hijji, Mohamad Alkhouli, Mohammad Sarraf, Chad J. Zack, Joseph F. Malouf, Vuyisile T Nkomo, Allison K. Cabalka, Guy S. Reeder, Charanjit Rihal, Mackram Eleid

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Percutaneous paravalvular leak (PVL) closure is an alternative treatment option for severely symptomatic, high-surgical risk patients with PVL. Some patients require multiple percutaneous PVL closure procedures. However, the procedural characteristics and success rate of re-do PVL closure have not been well studied. Aims: The aim of this study is to investigate the indications, procedural characteristics, technical success rate, and 30-day major adverse cardiovascular events (MACE) in patients who underwent re-do PVL closure. Methods: Consecutive patients who underwent percutaneous paramitral or paraaortic leak closure at Mayo Clinic, Rochester, Minnesota from 2004 through 2015 were studied. Clinical and procedural characteristics of patients who underwent re-do PVL closure were compared to age- and sex-matched patients who underwent their first percutaneous PVL closure. Procedure success and 30-day MACE were compared in both the groups. Results: Among 223 identified percutaneous PVL closures, 16 (7%) were re-do procedures. Patients who underwent re-do PVL closure were predominantly men (87.5%) with a mean age of 68±15 years and an estimated mean Society of Thoracic Surgery (STS) 30-day mortality of 4.6±2.8. Half of the re-do PVL closures were performed on mechanical valves and 62.5% were performed on paramitral defects. Indications for re-do PVL closure were: (1) emergence of new significant paravalvular defects in 50%, (2) incomplete index defect closure in 43.75%, and (3) index procedural complication in 6.25% of the cases. Procedural success was 75% in re-do procedures vs. 85.4% in age- and sex-matched control group (P=0.45). Thirty-day MACE was 12.5% in the re-do group compared to 4.2% in the age- and-sex matched patients who underwent PVL closure for the first time (P=0.35). Conclusion: Re-do percutaneous PVL closure is feasible with favorable procedural success rate and low 30-day MACE. Development of new paravalvular defects is the most common indication for re-do PVL closure, highlighting the importance of careful longitudinal monitoring and follow-up.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2017

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Thoracic Surgery
Research Design
Control Groups
Mortality
Therapeutics

Keywords

  • Heart failure
  • Hemolytic anemia
  • Paravalvular leak closure
  • Prosthetic valve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Characteristics and outcomes of re-do percutaneous paravalvular leak closure : Re-Do percutaneous paravalvular leak closure. / Al-Hijji, Mohammed A.; Alkhouli, Mohamad; Sarraf, Mohammad; Zack, Chad J.; Malouf, Joseph F.; Nkomo, Vuyisile T; Cabalka, Allison K.; Reeder, Guy S.; Rihal, Charanjit; Eleid, Mackram.

In: Catheterization and Cardiovascular Interventions, 2017.

Research output: Contribution to journalArticle

Al-Hijji, Mohammed A. ; Alkhouli, Mohamad ; Sarraf, Mohammad ; Zack, Chad J. ; Malouf, Joseph F. ; Nkomo, Vuyisile T ; Cabalka, Allison K. ; Reeder, Guy S. ; Rihal, Charanjit ; Eleid, Mackram. / Characteristics and outcomes of re-do percutaneous paravalvular leak closure : Re-Do percutaneous paravalvular leak closure. In: Catheterization and Cardiovascular Interventions. 2017.
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abstract = "Background: Percutaneous paravalvular leak (PVL) closure is an alternative treatment option for severely symptomatic, high-surgical risk patients with PVL. Some patients require multiple percutaneous PVL closure procedures. However, the procedural characteristics and success rate of re-do PVL closure have not been well studied. Aims: The aim of this study is to investigate the indications, procedural characteristics, technical success rate, and 30-day major adverse cardiovascular events (MACE) in patients who underwent re-do PVL closure. Methods: Consecutive patients who underwent percutaneous paramitral or paraaortic leak closure at Mayo Clinic, Rochester, Minnesota from 2004 through 2015 were studied. Clinical and procedural characteristics of patients who underwent re-do PVL closure were compared to age- and sex-matched patients who underwent their first percutaneous PVL closure. Procedure success and 30-day MACE were compared in both the groups. Results: Among 223 identified percutaneous PVL closures, 16 (7{\%}) were re-do procedures. Patients who underwent re-do PVL closure were predominantly men (87.5{\%}) with a mean age of 68±15 years and an estimated mean Society of Thoracic Surgery (STS) 30-day mortality of 4.6±2.8. Half of the re-do PVL closures were performed on mechanical valves and 62.5{\%} were performed on paramitral defects. Indications for re-do PVL closure were: (1) emergence of new significant paravalvular defects in 50{\%}, (2) incomplete index defect closure in 43.75{\%}, and (3) index procedural complication in 6.25{\%} of the cases. Procedural success was 75{\%} in re-do procedures vs. 85.4{\%} in age- and sex-matched control group (P=0.45). Thirty-day MACE was 12.5{\%} in the re-do group compared to 4.2{\%} in the age- and-sex matched patients who underwent PVL closure for the first time (P=0.35). Conclusion: Re-do percutaneous PVL closure is feasible with favorable procedural success rate and low 30-day MACE. Development of new paravalvular defects is the most common indication for re-do PVL closure, highlighting the importance of careful longitudinal monitoring and follow-up.",
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author = "Al-Hijji, {Mohammed A.} and Mohamad Alkhouli and Mohammad Sarraf and Zack, {Chad J.} and Malouf, {Joseph F.} and Nkomo, {Vuyisile T} and Cabalka, {Allison K.} and Reeder, {Guy S.} and Charanjit Rihal and Mackram Eleid",
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T1 - Characteristics and outcomes of re-do percutaneous paravalvular leak closure

T2 - Re-Do percutaneous paravalvular leak closure

AU - Al-Hijji, Mohammed A.

AU - Alkhouli, Mohamad

AU - Sarraf, Mohammad

AU - Zack, Chad J.

AU - Malouf, Joseph F.

AU - Nkomo, Vuyisile T

AU - Cabalka, Allison K.

AU - Reeder, Guy S.

AU - Rihal, Charanjit

AU - Eleid, Mackram

PY - 2017

Y1 - 2017

N2 - Background: Percutaneous paravalvular leak (PVL) closure is an alternative treatment option for severely symptomatic, high-surgical risk patients with PVL. Some patients require multiple percutaneous PVL closure procedures. However, the procedural characteristics and success rate of re-do PVL closure have not been well studied. Aims: The aim of this study is to investigate the indications, procedural characteristics, technical success rate, and 30-day major adverse cardiovascular events (MACE) in patients who underwent re-do PVL closure. Methods: Consecutive patients who underwent percutaneous paramitral or paraaortic leak closure at Mayo Clinic, Rochester, Minnesota from 2004 through 2015 were studied. Clinical and procedural characteristics of patients who underwent re-do PVL closure were compared to age- and sex-matched patients who underwent their first percutaneous PVL closure. Procedure success and 30-day MACE were compared in both the groups. Results: Among 223 identified percutaneous PVL closures, 16 (7%) were re-do procedures. Patients who underwent re-do PVL closure were predominantly men (87.5%) with a mean age of 68±15 years and an estimated mean Society of Thoracic Surgery (STS) 30-day mortality of 4.6±2.8. Half of the re-do PVL closures were performed on mechanical valves and 62.5% were performed on paramitral defects. Indications for re-do PVL closure were: (1) emergence of new significant paravalvular defects in 50%, (2) incomplete index defect closure in 43.75%, and (3) index procedural complication in 6.25% of the cases. Procedural success was 75% in re-do procedures vs. 85.4% in age- and sex-matched control group (P=0.45). Thirty-day MACE was 12.5% in the re-do group compared to 4.2% in the age- and-sex matched patients who underwent PVL closure for the first time (P=0.35). Conclusion: Re-do percutaneous PVL closure is feasible with favorable procedural success rate and low 30-day MACE. Development of new paravalvular defects is the most common indication for re-do PVL closure, highlighting the importance of careful longitudinal monitoring and follow-up.

AB - Background: Percutaneous paravalvular leak (PVL) closure is an alternative treatment option for severely symptomatic, high-surgical risk patients with PVL. Some patients require multiple percutaneous PVL closure procedures. However, the procedural characteristics and success rate of re-do PVL closure have not been well studied. Aims: The aim of this study is to investigate the indications, procedural characteristics, technical success rate, and 30-day major adverse cardiovascular events (MACE) in patients who underwent re-do PVL closure. Methods: Consecutive patients who underwent percutaneous paramitral or paraaortic leak closure at Mayo Clinic, Rochester, Minnesota from 2004 through 2015 were studied. Clinical and procedural characteristics of patients who underwent re-do PVL closure were compared to age- and sex-matched patients who underwent their first percutaneous PVL closure. Procedure success and 30-day MACE were compared in both the groups. Results: Among 223 identified percutaneous PVL closures, 16 (7%) were re-do procedures. Patients who underwent re-do PVL closure were predominantly men (87.5%) with a mean age of 68±15 years and an estimated mean Society of Thoracic Surgery (STS) 30-day mortality of 4.6±2.8. Half of the re-do PVL closures were performed on mechanical valves and 62.5% were performed on paramitral defects. Indications for re-do PVL closure were: (1) emergence of new significant paravalvular defects in 50%, (2) incomplete index defect closure in 43.75%, and (3) index procedural complication in 6.25% of the cases. Procedural success was 75% in re-do procedures vs. 85.4% in age- and sex-matched control group (P=0.45). Thirty-day MACE was 12.5% in the re-do group compared to 4.2% in the age- and-sex matched patients who underwent PVL closure for the first time (P=0.35). Conclusion: Re-do percutaneous PVL closure is feasible with favorable procedural success rate and low 30-day MACE. Development of new paravalvular defects is the most common indication for re-do PVL closure, highlighting the importance of careful longitudinal monitoring and follow-up.

KW - Heart failure

KW - Hemolytic anemia

KW - Paravalvular leak closure

KW - Prosthetic valve

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