Circulation. Cardiovascular interventions · 2017
Successful Percutaneous Mitral Paravalvular Leak Closure Is Associated With Improved Midterm Survival.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Alkhouli Mohamad, Zack Chad J, Sarraf Mohammad, Eleid Mackram F, Cabalka Allison K, Reeder Guy S, Hagler Donald J, Maalouf Joseph F, Nkomo Vuyisile T, Rihal Charanjit S
Аннотация
BACKGROUND: Percutaneous closure of prosthetic mitral valve paravalvular leak (PVL) has emerged as an alternative to surgical treatment in high-risk patients. Limited data exist on the impact of successful percutaneous PVL closure on midterm outcomes.
METHODS AND RESULTS: We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31-7.25) years. One hundred sixty-two patients (70%) had ≤mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ≤mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%; P=0.004) and lower all-cause mortality at 30 days (1% versus 14%; P<0.001) and 1 year (15% versus 39%; P<0.001). Survival at 3 years was 61% in patients who had ≤mild residual leak and 47% in patients with higher grade of residual PVL (P=0.002).
CONCLUSIONS: In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.
METHODS AND RESULTS: We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31-7.25) years. One hundred sixty-two patients (70%) had ≤mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ≤mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%; P=0.004) and lower all-cause mortality at 30 days (1% versus 14%; P<0.001) and 1 year (15% versus 39%; P<0.001). Survival at 3 years was 61% in patients who had ≤mild residual leak and 47% in patients with higher grade of residual PVL (P=0.002).
CONCLUSIONS: In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.