Elective Percutaneous Paravalvular Leak Closure Under Conscious Sedation: Procedural Techniques and Clinical Outcomes |
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| Institution: | 1. John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America;2. The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, United States of America;1. Division of Cardiology, Robert Packer Hospital, Guthrie Health Services, Sayre, PA, United States of America;2. Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America;3. Rutgers School of Medicine, Newark, NJ, United States of America;1. Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA;2. Department of Cardiology, Mount Sinai Hospital, New York, NY, USA;3. Chinatown Cardiology, PC, New York, NY, USA;1. St. Thomas Hospital, London, UK;2. Queen Elizabeth Hospital, Woolwich, London, UK;1. Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;2. Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy |
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| Abstract: | BackgroundParavalvular leaks (PVLs) are a well-recognized complication of prosthetic valves that are detected up to 18% of all implanted surgical valves. Perioperative morbidity is thought to be lower in percutaneous compared to surgical PVL repair. However, a direct comparison of PVL closure techniques has never been performed. Our study is the first to demonstrate that elective PVL closure with monitored anesthesia care can be achieved with high success and low complications rates resulting in short hospital stays.MethodsThis is a retrospective cohort of patients admitted electively for catheter-based treatment of symptomatic prosthetic paravalvular regurgitation from Jan 2013 to April 2018. Both mitral and aortic PVLs were included. Patients' demographics, risk factors, procedural outcomes, In-hospital and thirty-day mortality were all reported. We followed the Valve Academic Research Consortium (VARC) criteria to define device and procedural technical success. In-hospital and 30- day outcomes were assessed by retrospective chart review.ResultsA total of 54 PVLs in thirty-seven patients were repaired (65% aortic & 35% mitral). The mean-age in the mitral cohort was lower than the aortic cohort (61 vs 72 years, P < 0.0001) but the two groups shared similar clinical risk factors (P > 0.05). Average hospital stay was 1–2 days (<1.5 days overall cohort) which was significantly lower in the aortic compared to the mitral cohort (P = 0.009). All procedures were guided by TEE under conscious sedation with monitored anesthesia care. Procedural technical success defined as any significant residual shunt was 81% in the overall cohort and 88% in the aortic group. No procedural deaths were reported. Short-term mortality during the first 30 days was 5.4% (two patients).ConclusionElective catheter-based repair of symptomatic prosthetic paravalvular regurgitation appears to be safe and effective. The use of conscious sedation with monitored anesthesia care resulted in short hospital stay. |
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