Two‐Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non‐Randomized Analysis. Issue 4 (4th March 2016)

• Record Type: Journal Article
• Authors: Angulo‐Llanos, Rocío; Sarnago‐Cebada, Fernando; Rivera, Allan R.; Elízaga Corrales, Jaime; Cuerpo, Gregorio; Solis, Jorge; Gutierrez‐Ibañes, Enrique; Sanz‐Ruiz, Ricardo; Vázquez Álvarez, ME; Fernandez‐Avilés, Francisco
• Is Part Of: Catheterization and cardiovascular interventions. Volume 88:Issue 4(2016)
• Page Start: 626
• Page End: 634
• Publication Date: 2016-03-04
• Subjects: paravalvular leak -- percutaneous closure -- pulmonary hypertension; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26459
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative treatment. Predictors of survival and procedural success are unknown. Objectives: To review our experience in the treatment of PVL and evaluate efficacy, mortality, predictors of success, and outcomes. Methods: Retrospective review of percutaneous PVL procedures between years 2008 and 2014. Survival and results were compared with a control cohort of surgical patients. Results: Percutaneous closure was attempted in 51 patients. The surgical group had 36 patients. Defects were perimitral in 67 patients (77%). Mean follow‐up (FU) was 784.5 days. After propensity score analysis in‐hospital mortality was higher in the surgical group (30.6% vs. 9.8%, OR 6, P 0.01). Clinical improvement was higher in the percutaneous group (71.4% vs. 36.4%, P 0.002). Multivariate analysis showed normal creatinine (OR 15, P < 0.001) as independent predictor of clinical improvement. For the composite end‐point of all‐cause mortality or readmission, older age (OR 10.7, P 0.001), renal failure, (OR 18, P < 0.01), poor functional class and the absence of clinical improvement (OR 3.9, P < 0.001) were related with a higher risk. There were no differences in survival free from the composite end‐point according to the treatment received (surgical or percutaneous). Conclusion: Percutaneous PVL closure has a reasonable rate of success and low complication rates, and results compare favorably with surgical treatment. Older patients and those with poor functional class or renal failure (RF) showed a worse prognosis even after a successful closure. © 2016 Wiley Periodicals, Inc.