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40 Transcatheter paravalvular leak closure; a single centre experience
  1. R Tanner1,
  2. S Hassan1,
  3. N Ryan1,
  4. N Murphy1,
  5. P Campbell2,
  6. R Margey3,
  7. K Walsh1,
  8. G Blake1,
  9. IP Casserly1
  1. 1Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2St. Vincent's University Hospital, Dublin, Ireland
  3. 3Mater Private Hospital, Dublin, Ireland


Introduction Significant paravalvular leak (PVL) is estimated to occur in at least 1–2% of patients undergoing surgical aortic and/or mitral valve replacement, and 3–4% of patients undergoing percutaneous aortic valve replacement (TAVR). Surgery for repair of PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL has emerged as an alternative to surgical repair.

Methods Using a prospective registry, we sought to examine the clinical outcomes of patients treated with percutaneous closure of PVL at a tertiary referral hospital in Ireland.

Results A total of 21 patients (mean age 68 ±13 years, 76% male) were treated for PVL. Heart failure (HF) and haemolysis (HL) were the presenting symptoms in 62% and 24% of patients, respectively. The remaining 14% of patients presented with both HF and HL. Of the 21 prosthetic valves treated, 9 were in the mitral position, and 12 were in the aortic position. A total of 26 PVL procedures were performed in the 21 patients (mean of 1.2 procedures/patient). The mean number of plugs used per patients was 1.9 (range 0–4). There was one (3.8%) major adverse procedural complication (stroke) and two minor (7.7%) procedural complications (both vascular access complication treated with endovascular techniques). Among patients with HF as the presenting symptom (n=16), the mean NYHA class before and after percutaneous PVL closure was 2.6 ±0.62 versus 1.5 ± 0.63. None of these patients have required repeat surgery over a median follow-up of 20 months (IQR 9.5–32). Among patients with HL, clinical success was achieved in 2 of 5 patients (40%). A total of 6 deaths (28%) occurred in the patient cohort over a mean follow-up of 22 ±13.4 months. Thirty-day mortality was 0%. Figure 1 shows the Kaplan Meier Estimate of survival.

Conclusions Patients with PVL represent a high-risk patient cohort. Percutaneous PVL offers a safe alternative to surgical PVL repair, and appears particularly effective in those patients who present primarily with HF as their presenting symptom.

Abstract 40 Figure 1 Kaplan-Meier curve showing survival free from death by any cause

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