Case Report: Transcatheter closure of paravalvular leak following left ventricular assist device and aortic valve replacement.

BACKGROUND

End-stage dilated cardiomyopathy (DCM) is a common cause of end-stage heart failure, and some patients may eventually require heart transplantation. Such patients often need a left ventricular assist device (LVAD) as a bridge to heart transplantation, and those with severe aortic regurgitation may undergo concurrent aortic valve replacement. Paravalvular leak (PVL) is a complication following valve surgery that can lead to worsening heart failure; however, reports on transcatheter closure of PVL after LVAD implantation are rare.

CASE SUMMARY: This article reports the case of a 39-year-old male patient with DCM who underwent CorHeart 6 LVAD implantation, aortic bioprosthetic valve replacement, and tricuspid valvuloplasty due to end-stage heart failure. A follow-up echocardiogram 2 months post-surgery revealed a progressively worsening paravalvular leak around the aortic bioprosthetic valve (maximum regurgitant jet width 3.4 mm, regurgitant jet area 20.5 cm2), accompanied by worsening symptoms of heart failure. Due to the extremely high risk of redo surgery (STS score 16.2%), a multidisciplinary team consisting of cardiac surgeons, interventional cardiologists, intensive care physicians, and echocardiographers decided to perform transcatheter closure. The procedure was successfully performed via a retrograde approach through the right femoral artery, guided by fluoroscopy combined with transthoracic echocardiography. A 10 × 8 mm ventricular septal defect occluder was used to successfully seal the leak. Intraoperative angiography and echocardiography confirmed the satisfactory position of the occluder with no residual shunt. At the 2-month and 6-month follow-up visits post-procedure, the patient's cardiac function had improved to NYHA class II, echocardiography showed no residual PVL, and the left ventricular dimensions were slightly reduced compared to previous measurements.

CONCLUSION

This case suggests that transcatheter closure may be a safe and effective treatment option for high-risk patients who develop PVL following LVAD implantation combined with aortic valve replacement, providing a reference for the individualized management of similar complex cases.