Percutaneous repair of paravalvular prosthetic regurgitation: Acute and 30-day outcomes in 115 patients

Paul Sorajja, Allison K. Cabalka, Donald J. Hagler, Charanjit S. Rihal

Research output: Contribution to journalReview article

124 Scopus citations

Abstract

Background-Percutaneous repair has emerged as a potential therapy for patients with prosthetic paravalvular regurgitation. However, there is a relative paucity of data on the feasibility and outcome of this procedure. Methods and Results-All patients in whom percutaneous paravalvular regurgitation closure was attempted at our hospital were identified and included. Under echocardiographic and fluoroscopic guidance, patients underwent implantation of ≥1 an Amplatzer Septal Occluder, Duct Occluder, Muscular Ventricular Septal Defect Occluder, or Vascular Plug II. Percutaneous repair of 141 paravalvular defects was attempted in 115 patients (age, 67±12 years; men, 53%) with heart failure, hemolytic anemia, or both and who were at high risk of open surgery (mean estimated Society of Thoracic Surgeons mortality, 6.9%). Devices were implanted in 125 defects (89% of total defects), including in 19 patients with multiple defects. Because of the complexity of the procedures, wire exteriorization was required in 29 patients. Overall, successful percutaneous closure (defined as ≤1+ residual regurgitation) was achieved in 88 (77%) patients. Procedural time decreased with increasing case experience for percutaneous repair of both perimitral and periaortic defects. Overall, the 30-day complication rate was 8.7% (sudden and unexplained death, 1.7%; stroke, 2.6%; emergency surgery, 0.9%; bleeding, 5.2%). Two devices embolized during the procedure and were retrieved without sequelae. No procedural deaths occurred, but 2 (1.7%) patients died by 30 days. Conclusions-Percutaneous repair of paravalvular prosthetic regurgitation can be performed with a reasonable rate of procedural success and may be an initial therapeutic option, particularly in patients at significant risk for open surgery. Increased case experience is associated with shorter procedural time.

Original languageEnglish (US)
Pages (from-to)314-321
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number4
DOIs
StatePublished - Aug 1 2011

Keywords

  • Amplatzer occluder device
  • Angioplasty
  • Catheters
  • Regurgitation
  • Valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Percutaneous repair of paravalvular prosthetic regurgitation: Acute and 30-day outcomes in 115 patients'. Together they form a unique fingerprint.

  • Cite this