Percutaneous closure of mitral paravalvular leaks: A systematic review and meta-analysis

Background and aim of the study: The percutaneous closure of mitral paravalvular leak (PVL) is emerging as an alternative treatment for high-risk surgical candidates. Several cases have been reported, and a few small studies have been conducted to investigate the outcome of the technique. A meta-analysis of the combined data would be considered helpful in deriving more powerful data; hence, the study aim was to conduct a meta-analysis of the percutaneous closure of mitral PVLs, as reported in the medical literature. Methods: Searches were conducted of the PubMed, Embase, and CINAHL databases for reports of mitral PVL percutaneous closure. The data were extracted by two reviewers, who aggregated the information by using a random-effects model. Results: Eight studies were included in the meta-analysis, with a total of 100 patients. The percutaneous closure of mitral PVLs was associated with a 15% cardiovascular mortality during the first year of follow up. Clinical success was noted in 48% of patients, while 52% failed to show any clinical improvement. Failures were mainly attributed either to deployment failure (18%), to the presence of a persistent leak, to hemolysis, or both (31%). Procedure-related complications (e.g., bleeding, stroke, endocarditis) were observed in 16% of patients. Conclusion: The percutaneous closure of mitral PVLs carries a 15% risk of cardiovascular mortality. The reported mortality rates for surgically treated patients ranged from 12% to 37%, but most patients who underwent percutaneous closure were considered high-risk surgical candidates with multiple comorbidities. While percutaneous closure appears promising, the development of lesion-specific occluders, standardized imaging techniques and parameters, and the design of randomized clinical trials to compare the outcome of surgical versus percutaneous intervention, are required before any final judgment may be made.