JACC. Cardiovascular interventions · 2016
Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Alkhouli Mohamad, Sarraf Mohammad, Maor Elad, Sanon Saurabh, Cabalka Allison, Eleid Mackram F, Hagler Donald J, Pollak Peter, Reeder Guy, Rihal Charanjit S
Аннотация
OBJECTIVES: The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients.
BACKGROUND: Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited.
METHODS: All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms.
RESULTS: Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004).
CONCLUSIONS: Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.
BACKGROUND: Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited.
METHODS: All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms.
RESULTS: Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004).
CONCLUSIONS: Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.
Предметные рубрики MeSH
AgedAged, 80 and overAortic ValveCardiac CatheterizationDisease-Free SurvivalEchocardiography, Doppler, ColorEchocardiography, Three-DimensionalEchocardiography, TransesophagealEquipment DesignFemaleHeart Valve Prosthesis ImplantationHumansKaplan-Meier EstimateMaleMiddle AgedPostoperative ComplicationsRecovery of FunctionRetrospective StudiesRisk FactorsTime FactorsTreatment Outcome