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Percutaneous management of paravalvular leaks
  1. Joel P Giblett1,
  2. Lynne K Williams2,
  3. Narain Moorjani3,
  4. Patrick A Calvert2,4
  1. 1Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  2. 2Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  3. 3Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  4. 4Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Patrick A Calvert, Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK; paddy{at}doctors.org.uk

Abstract

Paravalvular leak (PVL) is a challenging complication of valve replacement surgery that can cause heart failure and haemolysis. Surgical repair is the traditional treatment for severe, symptomatic PVL, but many patients with PVL fall into high-risk categories for redo surgery. Percutaneous techniques for closure of PVL have been increasingly refined over the last decade with availability of approved purpose-specific devices for closure. Percutaneous closure requires a heart team approach, with attention paid to appropriate preprocedural and periprocedural imaging to ensure a successful closure with minimal residual leak or complication. There are limited studies addressing the selection of a percutaneous approach to PVL. No randomised trials comparing surgical and percutaneous repair have been conducted. Large national registries from the UK and Ireland and from Spain have demonstrated that high rates of technical success can be achieved, with mortality comparable with surgical repair. Six retrospective studies comparing surgical and percutaneous approaches have been published. These broadly show comparable technical success between the interventions, with reduced short-term mortality among patients treated percutaneously. Long-term outcomes were similar between both treatment options. Percutaneous repair is an attractive treatment option in many patients due to its reduced invasiveness and quicker recovery period. However, more prospective studies are needed to validate its place in the armamentarium of the heart team.

  • heart valve prosthesis
  • heart valve diseases
  • endovascular procedures
  • heart valve prosthesis implantation

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Footnotes

  • Contributors All authors discussed the content of the review. JPG drafted the manuscript. LKW provided figures for the review. LKW, NM and PAC provided critical review of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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