Successful percutaneous repair of perivalvular prosthetic regurgitation

Objective: To examine the feasibility and outcome of percutaneous transcatheter repair of perivalvular regurgitation. Background: Perivalvular prosthetic regurgitation causes significant morbidity, and is associated with high perioperative mortality if open surgical repair is required. Methods: Percutaneous repair of perivalvular regurgitation was attempted in 16 patients with heart failure or hemolytic anemia. All patients were either not candidates or were high-risk for open surgical repair (Parsonnet score, 39 ± 7). Regurgitant lesions were perimitral in 14 patients (2 had multiple defects) and peri-aortic in 2 patients. Under echocardiographic and fluoroscopic guidance, patients underwent implantation of either the Amplatzer Septal Occluder or Duct Occluder. Results: Successful percutaneous closure with mild or no residual regurgitation was achieved in 17 of 21 attempts (81%). In one patient, an occluder could not be deployed. There were no procedural deaths, strokes, or myocardial infarctions, and no prosthetic obstruction from device deployment. NYHA functional class improved from 3.1 ± 0.6 to 2.0 ± 1.0 at follow-up (mean, 3.1 mos; P = 0.0001 vs. baseline). One patient with heart failure had symptom resolution but died suddenly 4 weeks after the procedure. One subsequent noncardiac death and two late deaths from progressive heart failure also occurred. Conclusions: Percutaneous repair of perivalvular prosthetic regurgitation is a feasible alternative to open surgical correction, and may be preferred in patients at significant perioperative risk. Further experience with careful attention to patient selection, late morbidity, and mortality is required in this high risk patient subset.