Percutaneous Closure of Paravalvular Leaks - Single Centre Experience

Aim: To describe a method of paravalvular leak (PVL) closure using percutaneous closure devices. Background: PVL occurs in up to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to redo surgery. Methods: Patients with significant symptomatic PVL who are suitable for percutaneous leak closure and deemed high risk for redo surgery underwent attempted percutaneous PVL closure. Both percutaneous direct apical left ventricular puncture and retrograde approaches were used. Fluoroscopy and TOE were used for periprocedural guidance. Cardiac CT was used to plan the transapical approach. Amplatzer vascular plug III or Occulutech PLD device were used. Results: Between February 2014 and February 2017, ten patients, mean age 72.2 (54-85) with significant paraprosthetic mitral (n = 3) and aortic (n = 7) leaks underwent attempted percutaneous PVL closure. The success rate of the device implantation was 100%. Transapical approach was used in 2 patients, the remainder were transseptal, transfemoral or transradial approaches. Complications of the procedure were nil. At median follow-up of 276 days all patients were alive except one patient who died of metastatic cancer. NYHA functional class fell from IV to I and there were no hospital admissions for heart failure or anaemia. Pre- procedure leak was moderate or severe and at the end of procedure reduced to trivial in 6 patients, mild in 3 and moderate in one. Conclusions: Closure of mitral and aortic prosthetic paravalvular leaks using percutaneous closure devices with either a transapical or a retrograde approach appears safe and improves symptoms.