Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure

Mohamad Alkhouli, Mohammad Sarraf, Elad Maor, Saurabh Sanon, Allison Cabalka, Mackram Eleid, Donald J. Hagler, Peter Pollak, Guy Reeder, Charanjit Rihal

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25 Citations (Scopus)

Abstract

Objectives The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Background Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. Methods All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Results Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004). Conclusions Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.

Original languageEnglish (US)
Pages (from-to)2416-2426
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume9
Issue number23
DOIs
StatePublished - Dec 12 2016

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Hemolysis
Reoperation
Kaplan-Meier Estimate
Survival Analysis
Thoracic Surgery
Catheters
Heart Failure
Equipment and Supplies
Therapeutics

Keywords

  • aortic regurgitation
  • paravalvular leak
  • percutaneous repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure. / Alkhouli, Mohamad; Sarraf, Mohammad; Maor, Elad; Sanon, Saurabh; Cabalka, Allison; Eleid, Mackram; Hagler, Donald J.; Pollak, Peter; Reeder, Guy; Rihal, Charanjit.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 23, 12.12.2016, p. 2416-2426.

Research output: Contribution to journalArticle

Alkhouli, M, Sarraf, M, Maor, E, Sanon, S, Cabalka, A, Eleid, M, Hagler, DJ, Pollak, P, Reeder, G & Rihal, C 2016, 'Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure', JACC: Cardiovascular Interventions, vol. 9, no. 23, pp. 2416-2426. https://doi.org/10.1016/j.jcin.2016.08.038
Alkhouli, Mohamad ; Sarraf, Mohammad ; Maor, Elad ; Sanon, Saurabh ; Cabalka, Allison ; Eleid, Mackram ; Hagler, Donald J. ; Pollak, Peter ; Reeder, Guy ; Rihal, Charanjit. / Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 23. pp. 2416-2426.
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abstract = "Objectives The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Background Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. Methods All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Results Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70{\%} were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83{\%}, 5{\%}, and 12{\%}, respectively. Successful device deployment was accomplished in 94 defects (90{\%}). Reduction in PVL to mild or less was achieved in 62{\%} of patients. In-hospital major adverse events occurred in 8{\%} of procedures. Symptomatic improvement at 30 days was achieved in 64{\%} of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88{\%}) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2{\%} in patients who had mild or less residual leak compared with 68 ± 10{\%} in patients with higher grades of residual PVL (log-rank p = 0.004). Conclusions Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.",
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AU - Alkhouli, Mohamad

AU - Sarraf, Mohammad

AU - Maor, Elad

AU - Sanon, Saurabh

AU - Cabalka, Allison

AU - Eleid, Mackram

AU - Hagler, Donald J.

AU - Pollak, Peter

AU - Reeder, Guy

AU - Rihal, Charanjit

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N2 - Objectives The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Background Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. Methods All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Results Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004). Conclusions Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.

AB - Objectives The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Background Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. Methods All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Results Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004). Conclusions Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.

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