Cardiologie clinique et expérimentale
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Percutaneous Closure of Periprosthetic Paravalvular Leak: Single Center Experience

Giacomo Giovanni Boccuzzi, Catia De Rosa, Innocenzo Scrocca, Mauro De Benedictis, Emanuele Meliga, Tiziana Aranzulla, Eulogio Garcia and Maria Rosa Conte

Background: Clinical significant periprosthetic paravalvular leak (PVL) is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair in highrisk surgical patients. Aim: to evaluate the feasibility and efficacy of percutaneous closure of PVL using the Amplatzer vascular Plug III device in a consecutive series of patients referred to our structural heart disease center.
Methods: Between February 2010 and February 2013, 12 patients (mean age 68.3 ± 9.2 years, 66% male) who were believed to be poor operative candidates (heart team evaluation) underwent PVL closure with Amplatzer Vascular Plug III device.
Results: 58.3 % of patients had mitral paravalvular leak, 41.7% had aortic one. The median time since valve replacement (biologic prosthesis 88% and mechanical prosthesis 12%) was 36 ± 9 months. Technical procedural success was achieved in 92% of cases; in 6 patients (50%) more than one device was necessary. One intra-Hospital death occurs after fifteen days from procedure for non-cardiac causes. At follow up (ranging between 3-20 months) clinical success was achieved in 83% (10 of 12 patients). One patient underwent second procedure with third device implantation 49 days after first closure; one patient, with persistent residual leak and haemolysis parameters worsening, underwent surgical repair. At 12 month 83.3% of patients were alive.
Conclusions: In our experience, percutaneous closure of PVL is feasible and safe. It may be considered in selected patients in whom re-surgical intervention is deemed high-risk or is contraindicated.